If the condom fits, wear it: a qualitative study of young African-American men

This is an open access article - Copyright @ 2004 BMJ Publishing GroupObjective: To extend the current knowledge base pertaining to condom failure among young African-American men by assessing their experiences with male condom use. Methods: Qualitative assessments were conducted with 19 African-American men (aged 18–29 years) who had just been diagnosed with an STI and reported using condoms in the previous 3 months. Results: Five categories were identified from the data. These categories pertained to: (1) the “fit and feel” of condoms; (2) condom brand and size; (3) application problems; (4) availability of condoms and lubricants; and (5) commitment to condom use. Common themes included reasons why men believed condoms would break or slip off during sex. Comfort problems, including tightly fitting condoms and condoms drying out during intercourse, were mentioned frequently. Condom associated erection problems were often described. Many men also noted that condom use reduced the level of sexual satisfaction for their female partners. Men noted that finding the right kind of condom was not always easy and it became apparent during the interviews that men typically did not acquire lubrication to add to condoms. Despite their expressed problems with using condoms, men were, none the less, typically emphatic that condom use is an important part of their protective behaviour against STIs. Conclusion: Men were highly motivated to use condoms; however, they experienced a broad range of problems with condom use. With the exception of losing the sensation of skin to skin contact, the vast majority of these problems may be amenable to behavioural interventions.This study was funded by a grant from the National Institutes of Mental Health (1 R21 MH066682-01A1)

Is phosphodiesterase type 5 inhibitor use associated with condom breakage?

This is an open access article - Copyright © 2009 by the BMJ Publishing Group Ltd. All rights reserved.We tested the hypothesis that phosphodiesterase type 5 inhibitor (PDE5i) use would be associated with increased likelihood of condom breakage using an event-specific analysis. A convenience sample of 440 men completed an internetbased questionnaire that assessed variables pertaining to the last time they used condoms for penile-vaginal intercourse (PVI). A bivariate (screening) analysis was performed to identify covariates for a multivariate analysis using logistic regression. Altogether, 5.9% of the men reported breakage and 9.5% reported PDE5i use during the last time a condom was used for PVI. Among men who had used PDE5i during the last condom-protected occasion of PVI, 11.9% reported breakage compared with 5.3% of those not reporting PDE5i use. Adjusting for men’s age, ethnic minority status, marital status, reported duration of PVI and alcohol use at last PVI, those using PDE5i were about four times more likely to also report condom breakage (AOR 4.02; 95% CI 1.20 to 13.48; p=0.04). Of note, duration of PVI was independently associated with breakage (AOR 1.36; CI 1.02 to 1.83; p=0.04). Findings suggest that PDE5i use may potentially be associated with increased odds of condom breakage among some men.Support for this project was provided, in part, by the Rural Center for AIDS/ STD Prevention, a joint project of Indiana University, University of Colorado and the University of Kentucky, and by The Kinsey Institute, Indiana University

Does it fit okay? Problems with condom use as a function of self-reported poor fit

This is an open access article - Copyright © 2010 by the BMJ Publishing Group Ltd. All rights reservedOBJECTIVE: To identify associations between men's self-reports of ill-fitting condoms and selected condom use problems, using an event-specific analysis. METHODS: A convenience sample of men was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were: at least 18 years old, used condoms for penile–vaginal intercourse in the past 3 months and the ability to read English. RESULTS: In controlled, event-specific, analyses of 436 men, those reporting ill-fitting condoms (44.7%) were significantly more likely to report breakage (adjusted odds ratio (AOR 2.6), slippage (AOR 2.7), difficulty reaching orgasm, both for their female partners (AOR 1.9) and for themselves (AOR 2.3). In addition, they were more likely to report irritation of the penis (AOR 5.0) and reduced sexual pleasure, both for their female partner (AOR 1.6) and for themselves (AOR 2.4). Furthermore, they were more likely to report that condoms interfered with erection (AOR 2.0), caused erection loss (AOR 2.3), or became dry during sex (AOR 1.9). Finally, they were more likely to report removing condoms before penile–vaginal sex ended (AOR 2.0). CONCLUSIONS: Men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms.Support for this project was provided, in part, by the Rural Center for AIDS/STD Prevention, a joint project of Indiana University, University of Colorado, and the University of Kentucky and by The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University

Collisions and Mergers of Disk Galaxies: Hydrodynamics of Star Forming Gas

We summarize the results of numerical simulations of colliding gas-rich disk galaxies in which the impact velocity is set parallel to the spin axes of the two galaxies. The effects of varying the impact speed are studied with particular attention to the resulting gaseous structures and shockwave patterns, and the time needed to produce these structures. The simulations employ an N-body treatment of the stars and dark matter, together with an SPH treatment of the gas, in which all components of the models are gravitationally active. The results indicate that for such impact geometries, collisions can lead to the very rapid formation of a central, rapidly rotating, dense gas disk, and that in all cases extensive star formation is predicted by the very high gas densities and prevalence of shocks, both in the nucleus and out in the galactic disks. As the dense nucleus is forming, gas and stars are dispersed over very large volumes, and only fall back towards the nucleus over long times. In the case of low impact velocities, this takes an order of magnitude more time than that needed for the formation of a dense nucleus.Comment: To be published in Proceedings of 'The Evolution of Galaxies III- From simple approaches to self-consistent models,' held in Kiel, Germany, July 2002, Astrophysics and Space Science (Kluwer), vol. 284, p. 479, 200

Two heads are better than one: The association between condom decision-making and condom use errors and problems

This is an open access article - Copyright @ 2008 BMJ Publishing GroupObjectives: This exploratory study compared the frequency of condom use errors and problems between men reporting that condom use for penile–vaginal sex was a mutual decision compared with men making the decision unilaterally. Methods: Nearly 2000 people completed a web-based questionnaire. A sub-sample of 660 men reporting that they last used a condom for penile–vaginal sex (within the past three months) was analysed. Nine condom use errors/problems were assessed. Multivariate analyses controlled for men’s age, marital status, and level of experience using condoms. Results: Men’s unilateral decision-making was associated with increased odds of removing condoms before sex ended (adjusted odds ratio (AOR) 2.51, p=0.002), breakage (AOR 3.90, p=0.037), and slippage during withdrawal (AOR 2.04, p=0.019). Men’s self-reported level of experience using condoms was significantly associated with seven out of nine errors/problems, with those indicating less experience consistently reporting more errors/problems. Conclusions: Findings suggest that female involvement in the decision to use condoms for penile–vaginal sex may be partly protective against some condom errors/problems. Men’s self-reported level of experience using condoms may be a useful indicator of the need for education designed to promote the correct use of condoms. Education programmes may benefit men by urging them to involve their female partner in condom use decisions.Funding for this project was provided by the Canada Research Chair in Social Justice and Sexual Health at the University of Windsor, and the Rural Center for AIDS/STD Prevention and The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University

Men with broken condoms: Who and why?

This is an open access article - Copyright @ 2007 BMJ Publishing GroupObjectives: To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage. Methods: Young men (n=278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile–vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis. Results: Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the “fit or feel” of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0). Conclusions: Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.Financial Support for this project was provided by the Rural Center for AIDS/STD Prevention, a joint project of Indiana University, University of Colorado and University of Kentucky, and the Office of the Associate Dean of Research, School of Health, Physical Education, and Recreation, Indiana University

Differences in clinicopathologic variables between Borrelia C6 antigen seroreactive and Borrelia C6 seronegative glomerulopathy in dogs.

BackgroundRapidly progressive glomerulonephritis has been described in dogs that seroreact to Borrelia burgdorferi, but no studies have compared clinicopathologic differences in Lyme-seroreactive dogs with protein-losing nephropathy (PLN) versus dogs with Borrelia-seronegative PLN.Hypothesis/objectivesDogs with Borrelia C6 antigen-seroreactive PLN have distinct clinicopathologic findings when compared to dogs with Borrelia seronegative PLN.AnimalsForty dogs with PLN and Borrelia C6 antigen seroreactivity and 78 C6-seronegative temporally matched dogs with PLN.MethodsRetrospective prevalence case-control study. Clinical information was retrieved from records of dogs examined at the University of California, Davis, Veterinary Medical Teaching Hospital. Histopathologic findings in renal tissue procured by biopsy or necropsy of dogs with PLN were reviewed.ResultsRetrievers and retriever mixes were overrepresented in seroreactive dogs (P < .001). Seroreactive dogs were more likely to have thrombocytopenia (P < .001), azotemia (P = .002), hyperphosphatemia (P < .001), anemia (P < .001), and neutrophilia (P = .003). Hematuria, glucosuria, and pyuria despite negative urine culture were more likely in seroreactive dogs (all P ≤ .002). Histopathologic findings were consistent with immune-complex glomerulonephritis in 16 of 16 case dogs and 7 of 23 control dogs (P = 006). Prevalence of polyarthritis was not different between groups (P = .17).Conclusions and clinical importanceC6 seroreactivity in dogs with PLN is associated with a clinicopathologically distinct syndrome when compared with other types of PLN. Early recognition of this syndrome has the potential to improve outcomes through specific aggressive and early treatment

Jadelle subdermal contraceptive implant in Aminu Kano teaching hospital Kano, northern Nigeria

Background: Jadelle is a set of two flexible cylindrical implants consisting of a dimethylsiloxane/ methylvinylsiloxane copolymer core enclosed in thin-walled silicone tubing. It is an improved version of Norplant. Worldwide, it is found to be effective, safe, reversible and convenient for many users.Objective: To determine the acceptance rate, the Socio-demographic profile of the clients, post insertion complications and reason for discontinuation of the method among its acceptors in Aminu Kano Teaching Hospital, Kano.Study design: This is a retrospective descriptive study, involving all acceptors of Jadelle Subdermal implant in the family planning unit of Aminu Kano Teaching Hospital Kano, North western Nigeria.Results: A total of 1505 clients accepted contraceptive methods during the study period. Out of these, 102 had Jadelle inserted, giving a rate of 6.8%. All the clients who accepted Jadelle had it inserted for child spacing. The mean age of the clients at insertion was 28.9 years ± 6.1, the mean parity at insertion was 3.3± 1.8, while the mean weight at insertion was 63Kg ±11.4. About 94% of the clients had secondary and tertiary education. 42.2% of the clients had used a modern contraceptive method previously while the remaining 57.8% were using a modern method for the first time. Nine clients reported post insertion complication, pain at the site of insertion was reported by three clients, and pruritus was reported by one client and intermenstrual bleeding by five of the clients. Five women discontinued the method; 3(60%) was due to menorrhagia.Conclusion: The continuation rate of the method is high (95.1%). Majority of the acceptors (98%) had formal education, only 2% of the acceptors were illiterate. Public enlightenment will improve its use among the non literate women.Keywords: Jadelle, Subdermal implant, Kano, Northern Nigeri

Reducing the use of inhaled corticosteroids in mild-moderate COPD: an observational study in east London

Inhaled corticosteroids (ICS) are often prescribed for worsening breathlessness, exacerbation frequency or lung function in chronic obstructive pulmonary disease (COPD). In mild-moderate disease and infrequent exacerbations, treatment risks may outweigh benefits and ICS may be withdrawn safely under supervision. A systematic ICS deprescribing programme for patients with mild-moderate COPD was introduced in an east London Clinical Commissioning Group (CCG) in April 2017. Primary care patient record analysis found that prescribing fell from 34.9% (n = 701) in the 18 months pre-intervention to 26.9% (n = 538) by the second year of implementation, decreasing 0.84% per quarter post intervention (p = 0.006, linear regression). The relative decrease was greater than the comparison CCG (23.0% vs. 9.9%). Only South Asian ethnicity was associated with increased cessation (odds ratio 1.48, confidence interval (CI) 1.09-2.01), p = 0.013, logistic regression). Patient outcome data were not collected. A primary care-led programme comprising local education, financial incentivisation and consultant support led to a significant decrease in ICS prescribing