Does Race Influence Health-related Quality of Life and Toxicity Following Proton Therapy for Prostate Cancer?

OBJECTIVE: This matched-paired analysis explores disparities in health-related quality of life (QOL) and common toxicities between African American (AA) and white patients following proton therapy for prostate cancer at our institution. MATERIALS AND METHODS: A total of 1536 men with clinically localized prostate cancer were treated from 2006 to 2009 with definitive proton therapy to a median dose of 78 Gy +/- androgen deprivation therapy. A cohort of 92 consecutively treated AA men was matched to a cohort of 92 white men on the basis of National Comprehensive Cancer Network risk category and age. The 2 groups were compared with regard to comorbidities, demographics, and treatment regimen. Differences in genitourinary and gastrointestinal (GI) toxicity according to the Common Terminology Criteria for Adverse Events scale and QOL data from the Expanded Prostate Index Composite 26-question questionnaire were reported. RESULTS: Median follow-up was 2.1 years. Baseline patient and treatment characteristics were similar between the 2 groups with the exception of prostate-specific antigen ≥10 (32% for AAs vs. 20% for whites; P=0.068) and use of androgen deprivation therapy (26% for AAs vs. 21% for whites; P=0.38). No difference in Expanded Prostate Index Composite 26-question sexual summary, urinary incontinence, urinary obstruction, or bowel summary scores was detected between the 2 groups, nor was there a difference in grade 2 or higher GI toxicity (P=0.45). AAs had a statistically nonsignificant higher absolute incidence of late grade 3 genitourinary toxicity (4.4% vs. 0%; P=0.12). CONCLUSIONS: After 2 years, there were no disparities in health-related QOL, physician-reported Common Terminology Criteria for Adverse Events GI toxicity, or biochemical relapse. Longer follow-up is needed to confirm these findings.

The Last Bastion of Sexual and Gender Prejudice? Sexualities, Race, Gender, Religiosity, and Spirituality in the Examination of Prejudice Toward Sexual and Gender Minorities.

Prior research has reported that many Americans hold prejudicial attitudes toward sexual and gender minorities. Most of this research analyzed attitudes toward target categories in isolation and not in relation to attitudes toward heterosexuals. In addition, most previous research has not examined attitudes of members of sexual and gender minority categories toward other categories. While some research has examined the influence of religiosity on attitudes toward sexual and gender minorities, none of these studies has examined religiosity while also examining the influence of spirituality. In this article we drew on insights from queer theory to examine attitudes toward heterosexual, gay, lesbian, bisexual, and transgender individuals, as well as individuals who practice polygamy, among college students. Three samples gathered over a four-year period (2009, 2011, 2013) at a private, nonsectarian, midsized urban university in the Southeastern United States were used. We found that heterosexuals had the most positive rating, followed in order of rating by gay/lesbian, bisexual, and transgender individuals, and then those who practice polygamy. Regression analyses revealed gender and race were significant predictors of attitudes toward various sexual and gender categories. Holding a literalistic view of the Bible and self-identifying as more religious were related to more negative views toward sexual minorities, while self-identifying as more spiritual was related to more positive views.

Qualitative inquiry: perceptions of sexuality by African Americans experiencing haemodialysis.

AIM: To explore the influence of the haemodialysis regimen on African Americans' perceptions of sexuality. BACKGROUND: Sexuality is defined as the quality of humans as males or females. Sexuality concerns are commonly reported for individuals receiving haemodialysis; yet, sexuality-related research for this population has been limited to a focus on altered physical sexuality characteristics. DESIGN: Qualitative descriptive study. METHODS: This qualitative descriptive study used a middle-range model derived from Roy's adaptation model to explore a holistic viewpoint of African Americans' perceptions of physical sexuality, personal sexuality identity, family/social roles, and intimate/personal relationships since being on dialysis. Data were collected over a 9-month period in 2008-2009. FINDINGS: Semi-structured interviews were conducted with 19 African American men (N = 12) and women (N = 7) who were receiving haemodialysis treatment (mean age = 49·95 years). Perceptions of diminished sexuality were most associated with altered relationships, family and social roles for most participants, and were suggested to negatively influence adaptive processes. Perceptions of personal sexuality identity in male participants were found to be greatly influenced by endorsement of traditional masculinity ideology. In contrast, female participants' perceptions of sexuality were found to be influenced by multiple meanings of their identity as Black women. CONCLUSION: These findings suggest that diminished perceptions of sexuality may negatively influence adaptive processes for patients receiving chronic treatment such as dialysis. In addition, findings support further research and the development of instruments to assess sexuality from a more holistic viewpoint.

Ageing, sexuality and enhancement among Yoruba people in south western Nigeria.

Sexual health across the life course is influenced by biological and psychosocial factors. The paper explores sexuality and associated practices among older Yoruba people with a view to identifying the implications of cultural beliefs and practices for sexual health in later life. A total of 64 vignette-based in-depth interviews and 12 focus-group discussions were held with older adults (50-75 years) in two Yoruba communities in south western Nigeria. Findings portray sexuality as an important aspect of old age, with sexual intercourse being construed as having physical and spiritual consequences. This same perspective also emerged as participants' attributed factors affecting sexual desire in old age to religious beliefs, poverty, ill health and the non-availability of a partner. Gender differences were dominant on sexual desire and pleasure in old age. Participants' views on causes of sexual dysfunction identified biological, psychosocial and spiritual factors. Sexual decline in old age was considered redeemable with the support of biomedical and traditional medicines. However, only traditional medicine was considered beneficial in addressing sexual dysfunctions that had spiritual dimensions.

Israeli and Chinese partners of women with breast cancer: a cross-cultural view of marital issues.

OBJECTIVE: Cultural nuances may influence the interface between the cancer experience and marital issues, specifically for the partner. Most of the literature has focused on the woman's narrative or couple's adjustment to cancer in general. The purpose of this study was to describe and compare the marital relationship, sexuality, and marital adjustment of Israeli and Chinese husbands of women with breast cancer and the discussion of the health-care team concerning these issues. METHODS: A convenience sample of 50 Chinese and 50 Israeli men, ages of 28-79 years, completed components of the Psychological Adjustment to Illness Scale, the Locke Wallace Adjustment Scale, and a background questionnaire. RESULTS: The majority of husbands were in their first marriage. The average time since diagnosis was 16.7 months. No significant difference was found between the two groups on issues of marital relationship. Significant differences were found between Israeli and Chinese husbands on sexual interest, pleasure, and performance (p<0.05). Israeli husbands reported a significantly higher level of marital adjustment as opposed to the Chinese husbands (p = 0.006). Marital adjustment for both groups was significantly related only to perceived quality of the relationship (p<0.03). CONCLUSIONS: Significant cultural differences were found in sexuality variables with no differences discerned on marital relationship variables. Couple-based interventions for marital issues are a critical component of support for both partners. Culturally sensitive assessment and care of the spouse as well as the woman with breast cancer should be part of a holistic, comprehensive family care plan.

Between passion and repression: medical views of demon dreams, demonic fetuses, and female sexual madness in late imperial China.

This article argues that early Chinese physicians had already related female ailments to their sexual frustration. Moreover, many physicians paid more attention to non-reproductive women ­ nuns, widows, and unmarried women ­ as if they were more prone to suffer from unfulfilled desires and sexual frustration and, as a result, produce the sexual dreams and monstrous births that were described in the medical literature of medieval China as physical ailments. The earlier body-oriented etiology of these female illnesses gradually shifted to emotion-oriented perspectives in late imperial China. In particular, the sixteenth- and seventeenth-century doctors began to categorize women's sexual frustration as "yu disorders" or "love madness." In this article I will show not only the changing medical views of female sexual madness throughout the ages, but how these views were shaped by the societies in which both the doctors and patients were situated.

Culturally adapted cognitive-behavior therapy: integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino adolescent.

The article described and illustrated how a culturally adapted cognitive-behavioral therapy (CBT) can maintain fidelity to a treatment protocol while allowing for considerable flexibility to address a patient's values, preferences, and context. A manual-based CBT was used with a gay Latino adolescent regarding his sexual identity, family values, and spiritual ideas. The adolescent suffered from a major depression disorder and identified himself as gay and Christian within a conservative and machista Puerto Rican family. CBT promoted personal acceptance and active questioning of homophobic thoughts in a climate of family respect. CBT enabled identity formation and integration, central to the development of a sexual identity for lesbian, gay, bisexual, and transgender youth, with remission of the patient's depression and better family outcomes.

Constrained choices: adolescents speak on sexuality in Peru.

While numerous studies have explored young people's sexual behaviour in Peru, to date few have explored how adolescents situate sexuality within the context of their broader lives. This information is needed to inform policies and programmes. Life history interviews were conducted with 20 12-17-year-old young women and men from a low-income settlement near Lima, Peru. Data were analysed using holistic content analysis and grounded theory. Sexuality had a strong presence in respondents' lives. However, interviewees viewed the full expression of their sexuality as a constrained choice. Particular constraints derive from the belief that sexual intercourse always results in pregnancy; the nature of sex education; the provision of proscriptive advice; and the family tensions, economic problems, racism and violence present in young people's lives. The results of this study can inform policies and programmes to support young people as they make sexuality-related decisions.

See Josephus: viewing first-century sexual drama with Victorian eyes.

This article looks first at how the art of J.W. Waterhouse responds to the classical world: how complex the scene of reception is, triangulated between artist, the ancient past, and his audiences, and extended over time. Second, it looks at how this scene of reception engages with a specific Victorian problematic about male sexuality and self-control. This is not just a question of Waterhouse using classics as an alibi for thinking about desire, but also of the interference of different models of desire and different knowledges of the classical world in the reception of the painting's narrative semantics.

Moral transgression, disease and holistic health in the Livingstonia Mission in late nineteenth and early twentieth-century Malawi.

This article examines ideas of morality and health, and connections between moral transgression and disease in both Scottish missionary and Central African thought in the context of the Livingstonia Mission of the Presbyterian Free Church of Scotland in Malawi during the late nineteenth and early twentieth centuries. By concentrating on debates, conflicts and co-operation between missionaries and Africans over the key issues of beer drinking and sexual morality, this article explores the emergence of a new "moral hygiene" among African Christian communities in Northern Malawi.

"Born again is a sexual term": demons, STDs, and God's healing sperm.

In this article I examine the intersection between sexuality and spirit-filled bodies in American Evangelicalism. I am interested in investigating two issues: the sexual body as a site of spiritual battle and the use of popular science, especially the domain of genetics, as material evidence for this spiritual warfare. Specifically, I trace the increasingly spiritualized framing of marital intercourse in evangelical literature. To follow this trajectory, I highlight the spiritualized dangers of transgressive sexuality as well as the sexualizing of spirituality in evangelical sex manuals and deliverance manuals. This article centers around one text, Holy Sex: God's Purpose and Plan for Our Sexuality, whose authors' contend that sexually transmitted diseases are, in fact, demons lodged in genetic material that can be transferred through body fluids and bloodlines. The assertions about biology and demonic affliction made throughout the book are extreme and would be rejected by most readers of mainstream evangelical sex manuals. I argue that this book, though marginal, is not an irrelevant text. It reflects deep-seated anxieties about sexual bodies, spiritual concerns, and disease. Idiosyncratic though it may seem, Holy Sex taps into wider uncertainties about the spiritual vulnerability of the physical body found in contemporary evangelical literature.

Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young Aboriginal women in Adelaide.

Young Aboriginal women are consistently identified as having poorer health outcomes and access to sexual health services than non-Indigenous Australians. Yet the literature is particularly silent on what sexual health nurses need to know and do in order to work well with young urban Aboriginal women. This paper reports on a qualitative pilot study undertaken by a non-Indigenous nurse in Adelaide. The participatory action research methods used in this study were sensitive to the history of problems associated with research in Aboriginal communities. A reference group of Elder Aboriginal women and Aboriginal health workers guided all aspects of the study. A partnership approach between the researcher and the Reference Group ensured that the methods, analysis, and final report were culturally safe. Three groups participated in this study: Elders and Aboriginal health workers; young Aboriginal women, and sexual health nurses. All participants acknowledged the importance of nurses being clinically competent. However, the overarching finding was a lack of a clear model of cultural care to guide health service delivery. Three interrelated themes emerged from the data to support this contention. These were: the structural and personal importance of establishing and maintaining trustworthy relationships between nurses, Aboriginal health workers and Elders; the recognition that Aboriginal culture does exist, and is important in urban areas; and the importance of gender considerations to understanding urban women's health business. A partnership approach was recommended as a way to use these findings to develop a transparent cultural model of care. Further research is currently being undertaken to progress this agenda.

Jewish perspectives on pregnancy and childbearing.

There are approximately 6 million Jewish people in the United States today. They may be affiliated with the Orthodox, Conservative, or Reform streams of Jewish practice, or they may be secular and unaffiliated. Although religious practices and levels of observance among these streams of Judaism vary widely, nurses should become familiar with the religious traditions of Judaism in order to provide the most comprehensive care for a childbearing Jewish woman and her partner. This article describes the range of practices that may be observed, and offers information that may assist the nurse in providing culturally competent care. While it is important to tailor care to the individual needs of each childbearing couple, background knowledge of customs and traditions will help provide a basic context that can be used as a basis for understanding cultural variation and specific practices.

Dimensions of sexuality in the perimenopausal transition: a model for practice.

A biopsychosocial-cultural model of the sexuality of women during the perimenopausal transition includes dimensions related to physiology, psychosocial issues, and culture. It is an amalgam of biomedical and psychosocial models, yet has the added focus on culture. This holistic approach to sexual health is recommended by researchers and clinicians engaged in the study of midlife women. Clinicians can use this model to guide assessment and interventions, examining all of the dimensions of sexuality during the perimenopausal transition.