Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use : A Systematic Review

© CSIRO 2019. Open Access Article (CC BY-NC-ND)Continuing high rates of sexually transmissible infections (STIs) in many countries highlight the need to identify effective behavioural interventions. Consistent and correct use of male condoms is a key strategy for the prevention of STIs. However, some men report problems with condom fit (e.g. the size and shape of the condom) and feel (e.g. tightness, irritation, sensitivity), which inhibits their use. We conducted a systematic review to identify existing interventions addressing condom use fit and feel problems. We searched electronic databases for peer-reviewed articles and searched reference lists of retrieved studies. Five studies met the inclusion criteria. These were generally small-scale pilot studies evaluating behavioural interventions to promote safer sex with men aged under 30 years, addressing, among other things, barriers to condom use relating to fit and feel. There were significant increases in the reported use of condoms, including condom use with no errors and problems. Improvements in some condom use mediators were reported, such as condom use self-efficacy, knowledge, intentions and condom use experience. There were mixed findings in terms of the ability of interventions to reduce STI acquisition. Behavioural interventions addressing condom fit and feel are promising in terms of effectiveness but require further evaluation.Peer reviewe

Enhancing condom use experiences among young men to improve correct and consistent condom use:Feasibility of a Home-Based Intervention Strategy (HIS-UK)

Background: Condoms remain the main protection against sexually transmitted infections (STIs) when used correctly and consistently. Yet, there are many reported barriers to their use such as negative attitudes, reduced sexual pleasure, fit-and-feel problems and erection difficulties. The UK Home-Based Intervention Strategy (HIS-UK) is a behaviour change condom promotion intervention for use among young men (aged 16-25 years) designed to increase condom use by enhancing enjoyment of condom-protected intercourse. The objective of this feasibility study was to test HIS-UK for viability, operability and acceptability. Along with an assessment of the recruitment strategy and adherence to the intervention protocol, the study tested the reliability and suitability of a series of behavioural and condom use outcome measures to assess condom use attitudes, motivations, self-efficacy, use experience, errors and problems, and fit-and-feel.Methods: The HIS-UK intervention and associated assessment instruments were tested for feasibility using a single-arm, repeated measures design with baseline measurement and two follow-up measurements over three months. A three-month target of 50 young men completing the baseline questionnaire was set. Twenty process and acceptability evaluation interviews with participants and health promotion professionals were conducted post trial. Results: Of the 61 young men who registered for the study, 57 completed the baseline questionnaire and 33 met with the study researcher to receive the HIS-UK condom kit. Twenty-one young men remained for the duration of the study (64% retention). The Cronbach’s alpha scores for the condom use outcome measures were 0.84 Attitudes, 0.78 Self-efficacy, 0.83 Use experience, 0.69 Errors and problems, and 0.75 Fit-and-feel. Participant and health professional feedback indicated strong acceptability of the intervention. Conclusions: The feasibility study demonstrated that our recruitment strategy was appropriate and the target sample size was achieved. Adherence was favourable when compared to other similar studies. The condom use measures tested proved to be fit-for-purpose with good internal consistency. Some further development and subsequent piloting of HIS-UK is required prior to a full randomised-controlled trial, including the feasibility of collecting STI biomarkers, and assessment of participant acceptance of randomisation.Trial Registration: Research registry, RR2315, 27th March 2017 (retrospectively registered)<br/

Maria Cosway’s Hours: Cosmopolitan and Classical Visual Culture in Thomas Macklin’s Poets Gallery

Thomas Macklin’s Gallery of Poets opened at the Mitre Tavern in Fleet Street in 1788 with the aim to ‘display British Genius’ through ‘Prints Illustrative of the Most Celebrated British Poets’. Early newspaper coverage promised ‘a monument of the powers of the pencil in England, as the Vatican is at Rome’. The incongruous juxtaposition between Fleet Street and the Vatican spells out the cosmopolitan ambition of the literary gallery phenomenon through its real and imagined geographies of display. Through the format of the paper gallery of prints, Macklin’s Poets offered the inventions of British Poets as a repository of painting. This chapter examines how the cosmopolitan idiom of the paper gallery is negotiated in the first number of Macklin’s Poets. This essay examines the extent to which this ambition was achieved in the first Number of Macklin’s Poets which carried an engraving of Maria Cosway’s The Hours, originally a painting with an impressively European iconographic heritage. The painting was first exhibited at the Royal Academy in 1783, and was retroactively associated by Macklin with Thomas Gray’s ‘Ode on the Spring’. The trope of the Hours brought with it a weighty provenance derived from classical marble bas-relief, through the antiquarian pages of Pietro Santi Bartoli and Bernard de Montfaucon to Flaxman’s designs for Wedgwood plaques and vases. Cosway’s name also imported into Gray’s poem her reputation as a cosmopolitan, cultured woman who had completed the Grand Tour and who moved in elite circles including those of the Prince of Wales in London and the Duke of Orleans, Pierre d’Hancarville and Thomas Jefferson in Paris. The iconographies of the painting, the print, and the poem articulate a European cosmopolitan tradition for British Art

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570