Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice.

In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.

One-year follow-up of hospital nurses' work experiences during the COVID-19 pandemic: A qualitative study.

AIM: To follow up on the experiences of Registered Nurses (RNs) working after 1 year of the COVID-19 pandemic in Canadian and American hospitals. DESIGN: Semi-structured interviews were conducted, and transcripts were analysed through a reflexive thematic analysis (RTA). METHODS: RNs (n = 19) first interviewed in the spring of 2020 were re-interviewed 1 year after their original interviews (May 25, 2021-June 25, 2021). Participants consisted of nurses residing in Canada and working in Ontario (n = 12) or American hospitals (n = 7), i.e., both local and cross-border nurses. RESULTS: Five themes were identified: (1) "You call us heroes, but you forgot us": Nurses described experiences of disrespect and stigma from their communities, their government, and their workplaces. (2) "A whole new level of busy": Nurses reported stressors both at home and at work that had increased exponentially throughout the pandemic. (3) "Running on empty": Nurses described burnout and mental health struggles including depression, irritation, and suicidal ideation; they coped using both adaptive and maladaptive strategies. (4) "The job of nursing is painful": Ongoing pandemic issues led nurses to re-evaluate their commitments to their units, their hospitals and the profession itself. (5) "Surviving an un-survivable day": Nurses shared positive moments at work and home that helped give them the strength to carry on. CONCLUSION: Significant investments will be required from hospital organizations and governments to ensure that healthcare systems continue to function safely for patients, their families and nurses. IMPACT: The purpose of this study was to understand and describe nurses' experiences after 1 year of working during the COVID-19 pandemic. Nurses reported feeling disrespected, overwhelmed, and burned out; many were looking to leave the profession. These findings will be of interest to nurses working on the frontline of the pandemic as well as hospital managers and policy makers. NO PATIENT OR PUBLIC CONTRIBUTION: In this investigation, nurses were the participants.

"I Called us the Sacrificial Lambs": Experiences of Nurses Working in Border City Hospitals During the First Wave of the COVID-19 Pandemic.

BACKGROUND: The first wave of the COVID-19 pandemic had a significant impact on the personal and professional lives of frontline nurses. PURPOSE: The purpose of this descriptive phenomenological study was to explore the experiences of Canadian Registered Nurses (RNs) working in Ontario or United States hospitals during the first wave of the COVID-19 pandemic. METHODS: Semi-structured interviews were conducted with 36 RNs living in Ontario and employed either at an Ontario or United States hospital. Three main themes were identified across both healthcare contexts. RESULTS: 1) The Initial Response to the pandemic included a rapid onset of chaos and confusion, with significant changes in structure and patient care, often exacerbated by hospital management. Ethical concerns arose (e.g., redeployment, allocation of resources) and participants described negative emotional reactions. 2) Nurses described Managing the Pandemic by finding new ways to nurse and enhanced teamwork/camaraderie; they reported both struggle and resiliency while trying to maintain work and home life balance. Community responses were met with both appreciation and stigma. 3) Participants said they were Looking Forward to a "new normal", taking pride in patient improvements, accomplishments, and silver linings, with tempered optimism about the future. Many expressed a reaffirmation of their identities as nurses. Differences between participants working in the US and those working in Ontario were noted in several areas (e.g., initial levels of chaos, ethical concerns, community stigma). CONCLUSIONS: The COVID-19 pandemic has been very difficult for nursing as a profession. Close attention to post-pandemic issues is warranted.

Practical strategies and the need for psychological support: recommendations from nurses working in hospitals during the COVID-19 pandemic.

PURPOSE: Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have reported elevated levels of anxiety, burnout and sleep disruption. Hospital administrators are in a unique position to mitigate or exacerbate stressful working conditions. The goal of this study was to capture the recommendations of nurses providing frontline care during the pandemic. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted during the first wave of the COVID-19 pandemic, with 36 nurses living in Canada and working in Canada or the United States. FINDINGS: The following recommendations were identified from reflexive thematic analysis of interview transcripts: (1) The nurses emphasized the need for a leadership style that embodied visibility, availability and careful planning. (2) Information overload contributed to stress, and participants appealed for clear, consistent and transparent communication. (3) A more resilient healthcare supply chain was required to safeguard the distribution of equipment, supplies and medications. (4) Clear communication of policies related to sick leave, pay equity and workload was necessary. (5) Equity should be considered, particularly with regard to redeployment. (6) Nurses wanted psychological support offered by trusted providers, managers and peers. PRACTICAL IMPLICATIONS: Over-reliance on employee assistance programmes and other individualized approaches to virtual care were not well-received. An integrative systems-based approach is needed to address the multifaceted mental health outcomes and reduce the deleterious impact of the COVID-19 pandemic on the nursing workforce. ORIGINALITY/VALUE: Results of this study capture the recommendations made by nurses during in-depth interviews conducted early in the COVID-19 pandemic.

Where are We Now? A Consolidation of the Research on Long-term Impact of Child Sexual Abuse.

This manuscript provides an introduction to the special issue: Where are we now? A consolidation of the research on long-term impact of child sexual abuse. Over the past thirty years, there has been an explosion of research about the long-term impacts of childhood sexual abuse (CSA) on adult functioning and wellbeing. However, the consolidation of this vast literature has not kept up with the creation of new research despite the complexity and sophistication of these newer investigations. We have compiled a special issue of the Journal of Child Sexual Abuse to summarize and analyze this vast literature into a cohesive, consolidated whole. The goal of this issue was to consolidate recent research about the effects of CSA on alcohol and substance use in survivors, revictimization, sexual risk and sexual well-being and couple and parenting functioning.

Couple and parenting functioning of childhood sexual abuse survivors: a systematic review of the literature (2001-2018).

In this review, 55 unique empirical studies of the impacts of a history of CSA on couple and parenting functioning were identified and analyzed according to assumptions considered in an earlier review. Overall, this current systematic review supported earlier assumptions that CSA survivors would evidence insecure attachments in their adult couple relationships; that CSA survivors would be less likely to marry and more likely to divorce; and that partners would also experience difficulties in relation to their partnership with a CSA survivor. Assumptions about parenting functioning included: that CSA survivors would have different attitudes toward their children; that CSA survivors would function poorly as parents; and that children of CSA survivors would be at increased risk for sexual abuse. Evolutions in the literature since that first review included methodological improvements, as well as the inclusion of male survivors in some studies. More sophisticated statistical modeling allowed for a greater understanding of mediators and moderators in the relationship between CSA and later interpersonal functioning in couple relationships and in parenting. Recommendations for future research and clinical implications were proposed.

A Review of Mediators in the Association between Child Sexual Abuse and Revictimization in Romantic Relationships.

Child sexual abuse (CSA) is a widespread adverse experience that has multiple detrimental impacts in the long-term, affecting mental, sexual, and physical health of survivors. In addition, CSA may impede interpersonal functioning, and be associated with a heightened risk of revictimization. Recent review articles have summarized the possible risk factors associated with sexual revictimization, yet an increasing body of literature suggests that CSA may be a key risk factor for multiple forms (i.e., psychological, physical, sexual) of victimization occurring specifically in the context of intimate relationships, either in adolescence (dating violence) or adulthood (partner violence). Our understanding of the mechanisms linking CSA and dating violence or intimate partner violence is still limited. This systematic review of the literature is aimed at summarizing the identified mediators of the association between CSA and revictimization in romantic relationships in past empirical reports. A total of 18 studies meeting criteria were identified. Apart from PTSD, few potential mediators have been explored in more than one study. In addition, few studies have investigated protective factors that may reduce the risk of revictimization. Several limitations in the current literature were identified including issues related to definitions and measurement. Studies relying on longitudinal designs with representative samples are clearly needed to orient future prevention efforts and break the revictimization trajectory.

Hepatitis A outbreak in HIV-infected patients in Southeastern France: questions and responses?

During the 2017 European hepatitis A (HA) outbreak we assessed HA incidence in our cohort of 2300 HIV-infected patients, implemented preventive measures and evaluated practices and knowledge on sexually transmitted diseases (STD). HA incidence was assessed between 1 January 2017 and 31 December 2017 and included all symptomatic patients with virologically confirmed HA. Preventive measures consisted in identifying at risk and not immunised patients to propose them a free HAV vaccination, and an anonymous survey related to transmission routes of STD and to sexual behaviours. Twenty HA were diagnosed. All were homosexual men recently diagnosed with HIV and another STD. None were vaccinated against hepatitis A virus (HAV). Hospitalisation was required for 52%. We identified 250 patients at risk to acquire HAV and invited them to a free immunisation program. A total of 110 (44%) were vaccinated, of whom 74 responded to our survey. A majority of them (84%) reported recent active anal and oral sexuality with multiple (52%) male partners (81%), and ChemSex consumption (14%). Internet was the meeting link for 58%. Another STD history was found in 69%. One third of these individuals had no idea about STD transmission modes. This HA outbreak pointed the insufficient vaccine coverage against HAV and knowledge on STD, which may be improved by Internet.

Treatment of Low Sexual Desire or Frequency Using a Sexual Enhancement Group Couples Therapy Approach.

BACKGROUND: Sexual desire or frequency problems are exceedingly common, but treatment of them has been less than effective. AIM: The goal of this study was to develop a cost-effective, accessible intervention to deal with sexual desire or frequency problems, including sexual desire discrepancy, by enhancing the quality of couples' erotic intimacy. METHODS: 45 couples (38 heterosexual and 7 same-sex couples) distressed by sexual desire or frequency problems were seen in a 16-hour, group couples therapy intervention. Participants completed the New Sexual Satisfaction Scale (NSSS) at pretest, posttest, and at 6-month follow-up. OUTCOMES: The NSSS plus 3 additional items at pretest, posttest, and at 6-month follow-up and patients' written feedback. RESULTS: Statistically significant differences were found between pre-tests and post-tests in satisfaction with intensity of sexual arousal; creativity; frequency; sexual functioning; partner's sexual availability; partner's initiation of sexual activity; emotional opening up during sex; positive sexual reactions to the partner; communication of sexual wishes, preferences and desires; and balance between giving and receiving during sex. The largest improvement and effect sizes were found in overall satisfaction with one's sex life from pre-test to post-test and 6-month follow-up. CLINICAL IMPLICATIONS: Low sexual desire or frequency problems can be treated effectively by enhancing the quality of the couple's erotic connection, thereby creating desirable sex. STRENGTHS & LIMITATIONS: The strengths include the combination of quantitative and qualitative data. Limitations included the small number of same-sex couples. CONCLUSION: Sexual enhancement group couples therapy provides an effective, accessible, and affordable approach to low desire or frequency complaints in distressed couples. Kleinplatz PJ, Charest M, Paradis N, et al. Treatment of Low Sexual Desire or Frequency Using a Sexual Enhancement Group Couples Therapy Approach. J Sex Med 2020;17:1288-1296.