Absence of holistic sexual health understandings among men and women in deprived areas of Scotland: qualitative study.

BACKGROUND: There is a growing evidence base for the need for a holistic approach to sexual health improvement, but the challenges for realising this in the 'real world' may be harder in some communities than others. We examined sexual health understandings and behaviours among adult men and women in deprived areas of Scotland. METHODS: Thematic analysis, using the constant comparative method, of qualitative, semi-structured in-depth interviews with 19 men and 16 women aged 18-40 years from the most deprived areas of Glasgow, Edinburgh, Dundee, and three Highland towns. RESULTS: Even though most had been shown images designed to facilitate discussion about sexual consent and verbal/physical abuse, when first asked, participants overwhelmingly equated 'sexual health' with the avoidance of sexually transmitted infections (STIs) and pregnancy. Most of the women interviewed went on to locate their accounts of sexual health within a broader, social account of relationships that in an ideal world, in contrast with their everyday lives, were based on respect and freedom from violence. They expressed desires for more positive relationships, based on open communication and trust, choice and freedom from coercion. A few men did accept a broader definition of sexual health, but others actively resisted it and placed the onus to enact choices and freedom from coercion on women rather than men. CONCLUSIONS: In the first UK study to examine understandings of holistic sexual health among adults living in deprived areas, we found a disjuncture between men and women. These findings suggest that, as a society, we are failing to equip people to enhance their own, and others', sexual health and wellbeing in its broadest sense. New efforts to emphasise the breadth of sexual health are required, but addressing these complex issues, especially where there are negative underlying gender norms to challenge, will require multi-level interventions targeting individual, community and system levels.

Boundary-making in the medico-legal context: examining doctor-nurse dynamics in post-sexual assault forensic medical intervention.

A key dimension of the institutional response to sexual assault is the forensic medical examination of a victim's body conducted for purpose of documenting, collecting and testifying to corroborative evidence. Drawing upon in-depth interviews with forensic examiners and forensic nurse practitioners in one region of England, this study addresses a gap in the existing research on medico-legal processes, and critically examines the nature and dynamics of the relationship between doctors and nurses involved in this intervention. Using an analytic framework based on Thomas Gieryn's notion of 'boundary-work', we explore how this historically gendered dyadic relationship is experienced and understood in a context influenced by both medicine and law. We demonstrate very clear boundaries demarcating (i) physicians as experts and nurses as non-experts in the collection and representation of medical evidence, and, (ii) physicians as equated with technical competence and nurses with 'caring' duties. We conclude by positing implications that may stem from these professional relations with respect to sexual assault evidence, professionals and victims.

Innovating the Problem Away? A Critical Study of Anti-Rape Technologies.

In the context of expanding preventative strategies for addressing sexual violence, we are witnessing the emergence of an array of new anti-rape technologies targeted at women. These tools, promoted primarily through the Internet, include a variety of apps for mobile phones, signal- and alarm-emitting wearable technologies, and internal and external body devices. Based on analyses of websites promoting such instruments, we critically examine these devices with respect to their possible benefits, limitations, and unintended physical, social, and legal consequences for women. We suggest that unanticipated outcomes may undermine both victims and their cases, those the technologies are ostensibly designed to help.

A Rapid Review of Sexual Wellbeing Definitions and Measures: Should We Now Include Sexual Wellbeing Freedom?

An increasing number of studies refer to sexual wellbeing and/or seek to measure it, and the term appears across various policy documents, including sexual health frameworks in the UK. We conducted a rapid review to determine how sexual wellbeing has been defined, qualitatively explored and quantitatively measured. Eligible studies selected for inclusion from OVID Medline, PsychInfo, PubMed, Embase, CINAHL were: in English language, published after 2007, were peer-reviewed full articles, focused on sexual wellbeing (or proxies for, e.g. satisfaction, function), and quantitatively or qualitatively assessed sexual wellbeing. We included studies with participants aged 16-65. Given study heterogeneity, our synthesis and findings are reported using a narrative approach. We identified 162 papers, of which 10 offered a definition of sexual wellbeing. Drawing upon a socio-ecological model, we categorised the 59 dimensions we identified from studies under three main domains: cognitive-affect (31 dimensions); inter-personal (22 dimensions); and socio-cultural (6 dimensions). Only 11 papers were categorised under the socio-cultural domain, commonly focusing on gender inequalities or stigma. We discuss the importance of conceptualising sexual wellbeing as individually experienced but socially and structurally influenced, including assessing sexual wellbeing freedom: a person's freedom to achieve sexual wellbeing, or their real opportunities and liberties.

How men and women learn about sex: multi-generational perspectives on insufficient preparedness and prevailing gender norms in Scotland.

Attitudes towards sexual health and relationships are learned from a young age, and there is an ongoing need for innovative and comprehensive approaches to sex education that keep pace with rapidly changing contexts of people's lives. We used thematic analysis of data from two qualitative studies in Scotland to explore learning contexts from a multi-generational perspective, as well as the influence of different socio-cultural factors on provision, access to and experience of sex education. The importance, but inadequacy, of school as a source of learning, was a persistent theme over time. Participants' strategies to address perceived gaps in knowledge included experience, conversations, vicarious and online learning. Gender and age differences emerged, with younger participants more likely to go online for information, and prevailing gender norms shaping attitudes and behaviours across both study groups. Participants who identified as gay, lesbian or bisexual described feeling particularly unprepared for sex and relationships due to the narrow, heteronormative content received. Although schools continue to be a common source of information, it appears that they fail to equip young people for their post-school sexual life-course. We recommend the mandatory provision of comprehensive, positive, inclusive and skills-based learning to improve people's chances of forming and building healthy, positive relationships across the lifespan.

Exploring masculinities, sexual health and wellbeing across areas of high deprivation in Scotland: The depth of the challenge to improve understandings and practices.

Within and across areas of high deprivation, we explored constructions of masculinity in relation to sexual health and wellbeing, in what we believe to be the first UK study to take this approach. Our sample of 116 heterosexual men and women age 18-40 years took part in individual semi-structured interviews (n = 35) and focus group discussions (n = 18), across areas in Scotland. Drawing on a socio-ecological framework, findings revealed experience in places matter, with gender practices rooted in a domestically violent milieu, where localised, socio-cultural influences offered limited opportunities for more egalitarian performances of masculinity. We discuss the depths of the challenge in transforming masculinities in relation to sexual health and wellbeing in such communities.

Dynamic study of oxidative stress in renal dialysis patients based on breath ethane measured by optical spectroscopy.

The application of optical spectroscopy for rapid accurate measurement of breath biomarkers has opened up new possibilities for monitoring and diagnostics in recent years. Here, we report on how our recent advances in optical detection of ethane have enabled us to record dynamic breath ethane patterns for patients undergoing kidney dialysis. Ethane is well established as a breath biomarker for free radical induced cell degradation. Moreover, renal dialysis is known to induce such oxidative attack, and our measurements may offer insight into the nature of this assault. Specifically, we have discovered that patients undergo significant breath ethane elevation at the beginning of each dialysis session. We have found an inverse relationship between the magnitude of this effect and number of months patients have been receiving treatment. We comment on how further refinements of our technology will allow a more detailed evaluation of the ethane elevation effect and ultimately lead to the assessment of potential interventions.

Effect of maximal dynamic exercise on exhaled ethane and carbon monoxide levels in human, equine, and canine athletes.

Exercise-induced oxidative stress (EIOS) refers to a condition where the balance of free radical production and antioxidant systems is disturbed during exercise in favour of pro-oxidant free radicals. Breath ethane is a product of free radical-mediated oxidation of cell membrane lipids and is considered to be a reliable marker of oxidative stress. The heatshock protein, haem oxygenase, is induced by oxidative stress and degrades haemoglobin to bilirubin, with concurrent production of carbon monoxide (CO). The aim of this study was to investigate the effect of maximal exercise on exhaled ethane and CO in human, canine, and equine athletes. Human athletes (n = 8) performed a maximal exercise test on a treadmill, and canine (n = 12) and equine (n = 11) athletes exercised at gallop on a sand racetrack. Breath samples were taken at regular intervals during exercise in the human athletes, and immediately before and after exercise in the canine and equine athletes. Breath samples were stored in gas-impermeable bags for analysis of ethane by laser spectroscopy, and CO was measured directly using an electrochemical CO monitor. Maximal exercise was associated with significant increases in exhaled ethane in the human, equine, and canine athletes. Decreased concentrations of exhaled CO were detected after maximal exercise in the human athletes, but CO was rarely detectable in the canine and equine athletes. The ethane breath test allows non-invasive and real-time detection of oxidative stress, and this method will facilitate further investigation of the processes mediating EIOS in human and animal athletes.

Development of high-resolution real-time sub-ppb ethane spectroscopy and some pilot studies in life science.

We describe a high-resolution real-time spectroscopy system targeted to ethane gas with sensitivity > or = 70 ppt and response time from > or = 0.7 s. The measurement technique is based on a mid-IR lead-salt laser passing through a Herriott cell through which a gas sample flows. We compare wavelength scanning and locked configurations and discuss their relative merits. The technology has been motivated by clinical breath testing applications, ethane being widely regarded as the most important breath biomarker for cell damage via free-radical-mediated oxidative attack. We discuss preliminary human and animal studies in which ultrasensitive real-time ethane detection offers new diagnostic and monitoring potential.

An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK.

OBJECTIVE: The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics. DESIGN: Cost effectiveness based on decision model. Model probabilities were generated for a hypothetical sample of 250 women in each age group in each setting, based on prevalence studies, published data and expert opinion. A prospective observational study was used to generate data on prevalence and acceptability. SETTING: Antenatal, gynaecology and family planning clinics in Aberdeen, Edinburgh and Glasgow. SAMPLE: Prevalence was estimated in 2817 women. Acceptability was determined in 484 women. METHODS: An economic evaluation was performed using prevalence data from this and a previous study, and using outcome data from the literature and observational work. Incremental cost effectiveness ratios were estimated for each age group and clinical setting. Sensitivity analyses were performed to determine the robustness of incremental cost effectiveness ratios to changes in the incidence of long term sequelae and costs. The prevalence of infection was determined by nucleic acid amplification of urine samples or endocervical swabs. Knowledge of C. trachomatis and women's views of screening were determined using structured questionnaires. MAIN OUTCOME MEASURES: Direct health service costs of screening, incidence and costs associated with adverse sequelae, women's views of screening and prevalence of infection. RESULTS: The estimated cost of screening 250 women in each age group in each the four sample populations (total population of 3750) is 49,367 UK pounds, while preventing 64 major sequelae. This represents a net cost of 771.36 UK pounds in preventing one major sequela. Selective screening of all women under 20 years and all patients attending abortion clinics were shown to be the most cost effective strategies. These results were relatively insensitive to changes in estimated parameters, such as uptake rate, probabilities and unit costs of all major sequelae averted. Prevalence (95% CI) of infection in the highest risk groups (those aged under 20 in both antenatal and abortion clinics) was 12.1% (8.6-16.7) and 12.7% (7.3-21.2), respectively. The majority (>95%) of women agreed with a policy of regular screening for C. trachomatis, and screening in the settings employed in this study was largely acceptable. CONCLUSIONS: A single episode of screening for C. trachomatis does not result in net cost savings. Currently recommended strategies of screening for C. trachomatis in women under 25 years of age in abortion clinics are supported by our data on prevalence and acceptability. These data also suggest that hospital-based screening strategies should be further extended to include younger women attending antenatal clinics and all women of reproductive age attending colposcopy clinics.