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BACKGROUND/INTRODUCTION: Chemsex amongst men who have sex with men (MSM) is well documented in major cities within the United Kingdom (UK), but few data from less urban areas exist. We undertook a survey of sexual health clinic (SHC) healthcare workers (HCWs) to explore demand for and availability of chemsex services to understand training needs and inform service planning. METHODS: An online survey was distributed to HCWs in all SHCs across the UK. For English clinics, we explored associations between responses and geo-demographic region using national surveillance data and population statistics. RESULTS: Responses were received from 56% (150/270) of SHC's in the UK (89% (133/150) from English clinics). 80% (103/129) of UK clinics reported chemsex consultations and in 50% (65/129) these occurred at least monthly, with no significant difference found when analysed by the geo-demographic characteristics of England (p=0.38). Respondents from most clinics (99% (117/118)) wanted chemsex training, 81 %(103/129) felt there was a local clinical need for a chemsex service and 33% (14/43) had chemsex care-pathways for referrals in place. DISCUSSION/CONCLUSION: Patients reporting chemsex regularly present to SHCs throughout the UK including rural areas. Given the potential negative health outcomes associated with chemsex, there is a need for local, high quality, appropriate services and training to minimise harm.

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This was a cross-sectional study using an online survey to evaluate the provision of nurse-led and delivered services within genitourinary medicine in the UK. Results showed that such services are being widely utilised and are generally well supported by medical staff. The delivery of nurse-led and delivered services appears to be quite variable. Clinical guidelines and standards may help to ensure a more uniform approach to these services and help to maintain high standards of care.

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Breath methane excretion was measured in 274 healthy subjects from 2 rural communities in northern Nigeria. Studies in 24 adults showed a normal faecal flora with no enteric pathogens. Breath methane was detected in 122 (77%) of 159 adults, 19 (40%) of 47 older children (2-6 years), and 4 (8%) of 68 young children (< 2 years). Women were slightly more commonly breath methane-positive than men (82% versus 75%, respectively). Hyperventilation did not influence the specificity of the breath methane assay, although levels were circa 30% lower after deliberate hyperventilation. Methanogens were estimated by enrichment culture of faeces from 49 subjects. Of the subjects 76% had faecal methanogens estimated at > or = 10(2)/g, 45% at > or = 10(4)/g, and 16% at > or = 10(6)/g. There was no significant difference in distribution of methanogenic cultures between different age or tribal groups, and there were no obvious correlations between breath methane excretion and either the faecal carriage of methanogens per se or numbers present.

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1. The effect of acetate absorbed from the gut on glucose turnover has been determined in four healthy subjects during both fasting and an intravenous glucose infusion by using [U-13C]glucose. 2. In the first part of the study, after an overnight fast, a tracer dose of [U-13C]glucose was infused at a constant rate along with an infusion of saline for 7 h. In the second part the saline infusion was replaced by glucose at 4.25 mg min-1 kg-1. In both studies 15 mmol of sodium acetate was given by mouth at 15 min intervals from the fourth to the sixth hour. Glucose turnover, respiratory quotient, metabolic rate and blood levels of acetate, 3-hydroxybutyrate, lactate, insulin, glucagon and gastric inhibitory polypeptide were measured. 3. Glucose turnover rates (means +/- SEM) were 1.88 +/- 0.1 mg min-1 kg-1 during fasting and 4.0 +/- 0.08 mg min-1 kg-1 during glucose infusion. Acetate had no effect on glucose turnover, insulin, glucagon and gastric inhibitory polypeptide levels, but temporarily halted the rise in free fatty acids seen during the fasting study. No changes in oxygen consumption or carbon dioxide output occurred, in keeping with previous observations that acetate substitutes for lipid oxidation during metabolism and has no direct effect on glucose turnover.

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An investigation was made of the effect of changing mean transit time (MTT) by administration of drugs which affect colonic motility on faecal microbial mass in man. Senokot was used to accelerate and codeine and/or loperamide to prolong transit in subjects maintained on a constant high fibre diet. Doses of Senokot or codeine/loperamide were adjusted to halve or double transit time measured during a three week control period on diet alone. Stools were collected throughout and analysed for bacterial mass by a gravimetric procedure. Transit was measured by a continuous marker method. Senokot decreased mean transit time from 63.9 to 25.0 hours (n = 6), with increased stool weight from 148 to 285 g/day. Bacterial mass increased in all subjects from a mean of 16.5 to 20.3 g/day (dry weight) (p less than 0.025). Codeine/loperamide increased mean transit time from 47.1 to 87.6 hours (n = 5), with decreased stool weight from 182 to 119 g/day. Bacterial mass decreased in all but one subject from a mean of 18.9 to 16.1 g/day (NS). There was a significant correlation between transit time and bacterial mass in all three periods (r = 0.77, p less than 0.001). Changes in transit time are shown to alter microbial growth in the human colon and result in altered stool output, on a constant diet. Factors which affect transit may be as important as diet in determining large bowel function and hence susceptibility to disease.

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1. To evaluate the effect of age, sex and level of intake on the colonic response to wheat fibre, thirty healthy volunteers aged 17-62 years (nineteen men, eleven women) recruited from a local industry, were divided into four groups and given a controlled diet for two 3-week periods. The diet contained white bread during one period or one of four different amounts of bran-enriched wholemeal bread during the other (30, 60, 110, 170 g/d). 2. Wide variation was observed between subjects in stool weight on the basal diet and in response to wheat fibre. Stepwise regression analysis showed that the variation in stool weight was significantly related to sex (t 4.0, P less than 0.001) but not to age, height, weight or energy:fibre intakes on the basal diet. Stool weight in men (162 (SE 11) g/d) was approximately double that in women (83 (SE 11) g/d). Transit time and stool weight were closely related and the effect of sex on stool weight could be explained entirely by differences in transit. 3. The increase in stool weight with fibre was significantly related to dose (t 4.18, P less than 0.001) with approximately 1 g non-starch polysaccharides (the main component of dietary fibre) increasing stool weight by 5 g/d. Smaller increases in stool weight were seen in females, persons with initially low stool weights and small people. 4. Faecal carbohydrate excretion increased with the addition of bran mainly due to increased amounts of cellulose and pentose (arabinose + xylose), whilst digestibility of dietary non-starch polysaccharide fell from 77.6 (SE 2.3)% on the white bread diet to 65.6 (SE 2.4)% with the added bran (t 7.4, P less than 0.01, n26). 5. Faecal pH was more acid in men than in women and was related to methane production. Methane producers had higher faecal pH than non-producers (7.06 (SE 0.11) v. 6.65 (SE 0.1], lower stool weight (g/d; 93 (SE 12) v. 156 (SE 13] and slower transit times (h; 84.6 (SE 11.7) v. 48.6 (SE 6.6]. 6. These studies show that, when on similar diets, women have much lower stool weights and slower transit times than men. Furthermore, within the range of amounts of wheat fibre used in this and other published work, stool weight increases in linear proportion to the dose of fibre added to the diet. Methane excretion in breath is associated in this group of subjects with slow transit time and high faecal pH.

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1. The breakdown and faecal bulking capacity of dietary fibre preparations from wheat bran, apple, cabbage, carrot, and guar gum were compared in man and rat. 2. The degradation of the fibre showed good correlation between man and rat (r 0.99, regression coefficient 0.86). Wheat bran was the least well-digested, 66 and 59% of the neutral sugars being excreted in faeces of man and rat respectively. The breakdown of the fibre in apple, cabbage, carrot and guar gum was more complete and 4-29% of the neutral sugars were recovered in faeces. 3. The main dietary fibre constituents in each preparation were degraded to a similar extent in man and rat. The main dietary fibre constituents of apple, carrot, cabbage and guar gum were almost completely degraded. Of the xylose in wheat bran 45% (man) and 48% (rat) were recovered in faeces. However, the percentage excretion of glucose and arabinose from bran was higher in man. 4. A faecal glucan other than cellulose was identified in human faeces after guar gum, and has been provisionally identified as starch. No such glucan occurred in rat faeces. 5. A good correlation between the faecal bulking capacity in man and rat was seen (r 0.97, regression coefficient 0.56). Wheat bran had the best bulking capacity, while that of apple, cabbage, carrot and guar gum was less pronounced. Faecal bulking was inversely related to the amount of fibre which was water-soluble in each preparation. 6. It is concluded that this rat experimental model is useful for the prediction of fermentative breakdown and bulking capacity of dietary fibre in man. However, more comparative studies are needed to evaluate animal experiments regarding other physiological effects of dietary fibre.

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In a study of breath methane concentration 43 percent of males and 49 percent of females produced detectable amounts. The proportion of methane producers increased significantly with age in males but not in females. Obesity as measured by the sum of triceps, forearm, suprailiac and subscapular skinfolds was significantly less in producers than non-producers. Amongst methane producers there was also an inverse relationship between skinfold thickness and the breath methane concentration. Breath methane concentrations were lower in males than females. In addition, a higher proportion of methane producers was found amongst secretors of blood group substances (ABH antigen) than non-secretors.

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The nutritional consequences of the ingestion of NAS depend on the quantity ingested. At lower levels there is little effect on the absorption of other nutrients and the colonic microbiological-salvage mechanism operates and a substantial proportion of the energy is made available to the body through fermentation. The exact amounts that can be tolerated in this way vary for individuals and are different for different compounds. At higher levels of intake the capacity of the colonic digester is exceeded and the decreased transit time affects N, energy, electrolyte and water metabolism. The responses to NAS are an example of how the animal body is dependent on the bacterial content of the colon to enable that organ to perform its function of water and electrolyte conservation.

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To test the hypothesis that fecal magnesium excretion is related to fecal volume, fecal specimens were collected from healthy persons who drank 32 single doses of poorly absorbed carbohydrate (mannitol, lactulose or raffinose): the concentration of Mg(++) (Y) in fecal water (X) was linearly and inversely related to fecal volume-that is, Y = 42-0.03 X. In contrast, after drinking magnesium sulfate, the concentration of Mg(++) in fecal water rose and, except after the lowest ingested dose of 10 mmol, the points relating Mg(++) concentration and fecal volume were outside the upper 95% confidence limit of the linear regression line. These findings could be useful when physicians are analyzing stool specimens for supportive evidence of magnesium misuse in baffling cases of diarrhea.

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Average intakes of nonstarch polysaccharides (dietary fiber), foods, and nutrients were measured in representative samples of 30 men aged 50-59 in 4 Scandinavian populations with a 3-4 fold difference in risk for large bowel cancer. The assessment technique, a 4-day weighed record of food consumed and duplicate collections of all food eaten, was validated by chemical analysis of the duplicates, by measuring 24-hour urine and fecal nitrogen excretion, and by comparing the constituents of the urine samples collected during the survey with similar collections 1-2 weeks later. There were good agreements between estimates of fat and protein intake obtained by food-table calculations of the 4-day weighed record and the chemically analyzed duplicates. Urinary plus fecal nitrogen excretion was equal to estimated nitrogen intake during the survey, and no discernable changes in urinary output occurred after the survey, thereby implying that dietary habits had not changed as a result of the investigative technique. It is concluded that the dietary data are indicative of current patterns of food consumption and are sufficiently valid for comparison with data on cancer risk in the 4 areas.

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Nonstarch polysaccharide (NSP) intake was measured in representative samples of 30 men aged 50-59 in 2 urban and 2 rural Scandinavian populations that exhibited a 3-4 fold difference in incidence of large bowel cancer. Intake was measured by chemical analysis of complete duplicate portions of all food eaten over one day by each individual. NSP intakes showed a rural-urban gradient, with 18.4 +/- 7.8 g/day in rural Finland and 18.0 +/- 6.4 g/day in rural Denmark versus 14.5 +/- 5.4 g/day in urban Finland and 13.2 +/- 4.8 g/day in urban Denmark. NSP intakes were also calculated (using food tables) from weighed food records kept over 4 days, one of which was the day on which the duplicate collection was made. Intakes were 2-2.5 g/day higher with this method than with direct chemical analysis, mainly because published tables of values have become outdated and inaccurate as a result of improved methods for measuring NSP in food. Individual variation from day to day in NSP intake was considerable. Average NSP intake and intake of some of its component sugars were inversely related to colon cancer incidence in this geographical comparison. To show a relationship at the individual level between diet and cancer risk in a prospective study would require detailed and accurate methods for the assessment of NSP consumption.

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We measured fecal composition after giving oral doses of mannitol, lactulose, or raffinose to ileostomy patients and to normal subjects in order to determine the colon's capacity for metabolizing these carbohydrates and to decide whether volatile fatty acids (VFA) or unabsorbed carbohydrate initiated diarrhea. Seventy-four percent of mannitol, 100% of lactulose, and 88% of raffinose passed unabsorbed through the small intestine of six patients with ileostomies. Dose-response experiments revealed that normal subjects could tolerate 120-220 mmol of mannitol, 73-146 mmol of lactulose, or 80 mmol of raffinose before fecal output of water exceeded 400 ml in 48 h or before test carbohydrate appeared in the stool. Mannitol could be metabolized to glucose; lactulose to fructose, galactose, and glucose; and raffinose to sucrose, melibiose, fructose, galactose, and glucose. The output of VFA in fecal water did not correlate with the moles of carbohydrate metabolized, and it did not greatly exceed the output of VFA in stools of equal volume that were induced by nonfermentable MgSO4. We conclude that the human colon is capable of removing appreciable amounts of single doses of these carbohydrates from fecal water. When this capacity is exceeded, unabsorbed carbohydrate rather than VFA prompts an increased output of fecal water.

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1. The effect of dietary fibre digestion in the human gut on its ability to alter bowel habit and impair mineral absorption has been investigated using the technique of metablic balance. 2. Five healthy male students were studied for 9 weeks under controlled dietary conditions and during the last 6 weeks they took 36 g pectin/d. Bowel habit, transit through the gut, faecal fibre excretion, calcium balance and faecal composition were measured. 3. During the control period only 15% of the dietary fibre ingested was excreted in the stools and when pectin was added to the diet there was no increase in fibre excretion. Stool frequency and mean transit time were unchanged by pectin but stool wet weight increased by 33% and faecal excretion increased (%) for fatty acids 80, nitrogen 47, total dry matter 28 and bile acids 35. Ca balance remained unchanged. 4. It may be concluded from these results that dietary fibre is largely metabolized in the human gut and dietary pectin completely so. This could explain its lack of effect on bowel habit and Ca balance. Other changes in the faeces may be related to an increase in bacterial mass.

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Epidemiological observations and animal experiments suggest that large bowel cancer is related to serveral factors. Among them, high dietary intakes of animal fat, the presence in the colon of relatively high levels of bile acids, specific patterns of intestinal microflora, slow transit through the gut, and low stool weights. Under metabolic conditions we have observed the effect on these variables of dietes containing 62 or 152 g/day of fat mainly of animal origin in six healthy young men over 4-wk periods. No change attributable to the diet was observed in the subjects' bowel habit, fecal weight, mean transit time through the gut, or in the excretion of dry matter. Total fecal bile acid excretion was significantly higher on the high fat diet (320 +/- 120 mg/day) than on the low fat diet (139.7) +/- 63 mg/day) t test = 7.78 P less than 0.001 as also was the total fecal fatty acid excretion, 3.1+/-0.71 and 1.14+/-0.35 g/day, respectively t test = 11.4 P less than 0.001). The fecal microflora including the nuclear dehydrogenating clostridia were unaltered by the dietary changes as was fecal beta-glucuronidase activity. Dietary changes which increase animal fat intake clearly influence fecal bile acid excretion in a way that would favor the development of large bowel cancer if current theories prove to be true. Dietary fat however has no effect on overall colonic function so other components of the diet must be responsible for the observed associations of bowel cancer with slow transit and reduced fecal bulk.

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In 30 patients with cancer of the large bowel, 24 (80%) had detectable levels of methane in their breath, compared with 25 (39%) of 64 patients with non-malignant large-bowel disease and 83 (40%) of 208 subjects without large-bowel disease. These findings suggest that there may be a difference in anaerobic intestinal flora between patients with cancer of the large bowel and those without the disease. This difference may antedate the development of the tumour or, alternatively, result from the tumour.

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