An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men.

BACKGROUND: Men who have sex with men (MSM) are at increased risk of HIV infection in both high- and low-income settings. Mass media campaigns have been used as a means of communicating HIV health promotion messages to large audiences of MSM. There is no consensus on which designs are most appropriate to evaluate the process and outcomes of such interventions. METHODS: An exploratory review was conducted to assess research examining awareness, acceptability, effects on HIV testing, disclosure and sexual risk, and cost-effectiveness of HIV mass media campaigns targeting MSM. We searched for quantitative and qualitative studies published between 1990 and May 2011 via the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Psych Info, ISI Web of Science, OpenGrey and COPAC, and contacting experts. No exclusions were made on the basis of study design or methods because our primary aim was to map evidence. We appraised study quality and present a narrative synthesis of findings. RESULTS: Sixteen reports from 12 studies were included. All were from high-income countries and most examined multi-media interventions. Half of the studies were single cross-sectional surveys. Three repeat cross-sectional studies collected data pre and post the campaign launch. The remaining three studies monitored routine data. Three studies included a nested qualitative component. Campaign coverage was the most commonly reported outcome (9 studies). Imagery, tone of language, content and relevance were identified in the qualitative research as factors influencing campaign acceptability. HIV testing rates (or intention to test) were reported by five studies. Two studies reported that testing rates were higher among men who had seen the campaigns compared to men who had not, but this may reflect confounding. Findings were less consistent regarding reductions in sexual risk behaviours (4 studies). None of the studies examined cost-effectiveness. CONCLUSIONS: Campaigns aim to provide MSM with information to help prevent transmission of HIV and to address increasing motivation and changing norms towards precautionary behaviours. However, the limitations of mass media in imparting skills in effecting behaviour change should be recognised, and campaigns supplemented by additional components may be better-suited to achieving these goals

Simple steps to develop trial follow-up procedures.

BACKGROUND: Loss to follow-up in randomised controlled trials reduces statistical power and increases the potential for bias. Almost half of all trials fail to achieve their follow-up target. Statistical methods have been described for handling losses to follow-up and systematic reviews have identified interventions that increase follow-up. However, there is little guidance on how to develop practical follow-up procedures. This paper describes the development of follow-up procedures in a pilot randomised controlled trial of a sexual health intervention that required participants to provide and return questionnaires and chlamydia test samples in the post. We identified effective methods to increase follow-up from systematic reviews. We developed and tested prototype procedures to identify barriers to follow-up completion. We asked trial participants about their views on our follow-up procedures and revised the methods accordingly. RESULTS: We identified 17 strategies to increase follow-up and employed all but five. We found that some postal test kits do not fit through letterboxes and that that the test instructions were complicated. After identifying the appropriate sized test kit and simplifying the instructions, we obtained user opinions. Users wanted kits to be sent in coloured envelopes (so that they could identify them easily), with simple instructions and questionnaires and wanted to be notified before we sent the kits. We achieved 92 % (183/200) overall follow-up for the postal questionnaire at 1 month and 82 % (163/200) at 12 months. We achieved 86 % (171/200) overall follow-up for the postal chlamydia test at 3 months and 80 % (160/200) at 12 months. CONCLUSIONS: By using established methods to increase follow-up, testing prototype procedures and seeking user opinions, we achieved higher follow-up than previous sexual health trials. However, it is not possible to determine if the increase in response was due to our follow-up procedures. TRIAL REGISTRATION: Current Controlled Trials ISRCTN02304709 Date of registration: 27 March 2013

Erratum to: Simple steps to develop trial follow-up procedures.

Unfortunately, the original version of this article [1] contained an error. There were errors in the reference numbers in Additional file 1. This has now been corrected and Additional file 1 is included here with the correct reference numbers

The devil in disguise a comparative study of Thomas Mann's "Doktor Faustus" (1947) and Klaus Mann's "Mephisto" (1936), focussing on the role of art as an allegory of the rise and fall of Nazi Germany

This thesis compares the novels Doktor Faustus: das Leben des deutschen Tonsetzers Adrian Leverkühn, erzählt von einem Freunde (Thomas Mann) and Mephisto: Roman einer Karriere (Klaus Mann), insofar as they are portrayals of the situation in Germany during the Third Reich. Essentially a comparative study, I explore similarities and differences – thematic and conceptual – by situating both novels in their socio-historical moment (Chapter 1), exploring their conceptions of German national identity (Chapter 2), tracing intertextual connections to other works (Chapter 3), and, finally, examining their understanding of and reliance on art as insofar as it provides the allegorical framework for their respective portrayals of Nazi Germany (Chapter 4)

Feasibility of a self-completed history questionnaire in women requesting repeat combined hormonal contraception.

OBJECTIVE: To measure agreement between the client's and the clinician's responses to questions regarding client history as answered on a questionnaire based on the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) for combined hormonal contraception (CHC). METHODS: Clients aged 18 years and over, attending a central London community contraceptive clinic requesting a repeat supply of CHC, completed a history questionnaire and an evaluation form. Clinicians then completed their copy of the same questionnaire during the consultation. Percentage agreement and the Kappa statistic were used to assess the level of client-clinician agreement. RESULTS: Data from 328 client-clinician pairs were analysed. Agreement was above 93% for all identified risk factors. There was complete agreement for thrombosis, diabetes, stroke, cancer and liver problems. Least agreement was noted in the recording of migraine and abnormal bleeding. For all risk factors except smoking, the proportion of clients reporting a risk factor was more than the proportion of clinicians reporting a risk factor. No clinically important information relevant to a particular client's use of CHC was missed and none of them would have been wrongly prescribed the CHC based just on their self-completed questionnaires. Most women (97%) were happy with this method of history taking. CONCLUSIONS: A self-completed history questionnaire is acceptable to women and can potentially replace traditional routine medical history taking for continuing CHC. Women completed the questionnaire with a high degree of reliability. There was complete client-clinician agreement on UKMEC Category 4 criteria. Overall, clients reported more risk factors than clinicians, which increases the safety of the questionnaire

Decisional support for young people who self-harm: protocol for a feasibility trial

Introduction: Self-harm is common in adolescents and it is the strongest predictor of suicide. Young people who self-harm are often unsure of how and where to get help. Decision aids (DA) have been shown to help with decisional conflict where there is uncertainty around different options. We have developed an online DA to support young people in help-seeking for self-harm. A feasibility trial will examine the acceptability of the online intervention, and the ability to recruit and follow-up participants within a school setting. Methods and Analysis: In this parallel arm, single blind feasibility trial, 60 participants aged 12-18 years who have self-harmed in the past 12 months, will be randomised to either: 1) a group receiving the online DA or 2) a control group receiving general information about feelings and emotions. Both groups will complete measures assessing decision-making and help-seeking behaviour. The school counsellor will be notified of any participants who have been randomised to ensure safeguarding for the young person. Participants in both groups will be followed up at 4-weeks and the measures will be repeated. Qualitative interviews will be conducted with a subset of participants to explore their views and experiences of the DA and of participation in the study. Ethics and Dissemination: Ethical approval was granted by King’s College London (KCL) College Research Ethics Committee. Results of this study will help to clarify if we can recruit and administer an online decisional support intervention within a school setting for young people who self-harm. The study will inform the design and implementation of a larger randomised controlled trial to test the effectiveness of the DA. Dissemination of the study findings will target publication in peer-reviewed journals of general and special interest. The funder will be sent a report outlining the major findings of the study

Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness.

INTRODUCTION: Loneliness is prevalent and associated with negative health outcomes in young people. Our understanding of how it can be best addressed is limited. This systematic review aims to assess the acceptability and effectiveness of interventions to reduce and prevent loneliness and social isolation in young people. METHODS: Six bibliographic databases were searched; references of included studies were screened for relevant literature. A pre-defined framework was used for data extraction. Quality appraisal was performed using the Mixed Method Appraisal Tool. Data were synthesised narratively. RESULTS: 9,358 unique references were identified; 28 publications from 16 interventions met the inclusion criteria. The majority of interventions were high intensity, individual or small group interventions, often targeted at specific 'at risk' populations. While 14 interventions were associated with a statistically significant reduction in loneliness or social isolation, the heterogeneous measures of loneliness, small sample sizes, short periods of follow-up and high attrition rates limit evidence on effectiveness. Interventions implemented in more general populations of young people appeared more acceptable than those in specific 'at risk' populations. CONCLUSION: High intensity interventions are unlikely to be feasible at a population level. Further work is required to develop and evaluate theoretically-informed loneliness interventions for young people that reach wider audiences

Changes in the prevalence and profile of users of contraception in Britain 2000-2010: evidence from two National Surveys of Sexual Attitudes and Lifestyles.

AIM: To describe prevalence and trends in contraceptive method use in Britain through a comparison of the second and third National Surveys of Sexual Attitudes and Lifestyles (Natsal-2 and Natsal-3). METHODS: Cross-sectional probability sample surveys. General population sample of women aged 16-44 years, resident in Britain, with ever-experience of vaginal sex and, for analysis by sociodemographic characteristics, vaginal sex in the last year. Main outcome measure was current contraceptive method use ('usual these days'), categorised by effectiveness. RESULTS: Prevalence of current contraceptive use among women who had ever had vaginal sex declined between Natsal-2 and Natsal-3, 83.5% (95% CI 82.4 to 84.5) and 76.4% (95% CI 75.0 to 77.7), respectively. The condom and oral contraceptive pill remain the most commonly used methods. One in five women reported use of a most effective method. While no difference was found between surveys in use of most effective methods, a decline in sterilisation use was compensated by an increase in long-acting reversible contraceptive (LARC) use. Increased LARC use was particularly evident among under-25s compared with women aged 40-44 years (OR 11.35, 95% CI 3.23 to 39.87) and a decline was observed among those with two or more children relative to those with none (OR 0.21, 95% CI 0.13 to 0.35). CONCLUSIONS: Strategies to improve access to LARC methods have been particularly successful in increasing uptake among young people in the first decade of the 21st century. Whether this trajectory is maintained given changing sociodemographic characteristics and more recent financial cuts to sexual health service provision will warrant investigation

The English National Chlamydia Screening Programme: variations in positivity in 2007/2008.

BACKGROUND: The purpose of this study was to examine variation in positivity within the English National Chlamydia Screening Programme during 2007/2008. METHODS: Data were analyzed using multivariable logistic regression. The outcome measure was positivity. Funnel plots were used to explore variation in positivity according to screening volume. RESULTS: Three hundred and thirty-four thousand nine hundred and two screening tests were done, 29% of which were in men. Overall positivity was 7.6% in men and 9.3% in women. For men, positivity increased rapidly to plateau from ages 19 to 24. For women, rates peaked at 18 years-those aged 21 being at the same risk of chlamydial infection as 16-year-olds. For men and women, positivity was generally higher for those of black or mixed ethnicity compared with whites, whereas Asians were at lower risk. Similarly, risk of infection for men and women varied by screening venue. Multivariable analysis showed that, for men and women positivity varied significantly with age, ethnicity, screening venue attended, whether the young people had had a new sexual partner in the past 3 months, and whether the patient had had 2 or more sexual partners in the past year. Positivity did not vary significantly with implementation phase. CONCLUSIONS: This is the largest description of testing for Chlamydia trachomatis in healthcare and nonhealthcare settings outside Genitourinary Medicine clinics in England and allowed a detailed analysis of positivity by age and ethnic group. Considerable heterogeneity exists and local health service commissioners need to ensure that the implementation of chlamydial screening reflects these differences

Web-based decision-aid to assist help-seeking choices for young people who self-harm: outcomes from a randomised controlled feasibility trial

Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seeking help for their self-harm. Objective: Our aim was to evaluate the feasibility and acceptability of the DA intervention and the randomised controlled trial (RCT) in a school setting. Methods: We conducted a 2-group, single blind, randomised controlled feasibility trial in a school setting. Participants aged 12-18 years who reported self-harm in the past 12 months were randomised to either a web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomisation and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision-making and help-seeking behaviour. Qualitative interviews were conducted with young people, parents/carers and staff, and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 208 (18%) of the 1,164 parent/guardians contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 82% (n=170) of young people into the study. Of those young people screened, 14% (n=23) had self-harmed in the past year. Ten participants were randomised to receiving the DA and 13 were randomised to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and/or the intervention are needed before generalisable research about DAs can be successfully conducted in a school setting