Drug eruptions and the vulva.

Drug reactions affecting the vulva are understudied and underreported, with some having the potential to cause serious morbidity through long-term sequelae. We conducted a literature review to investigate the current evidence about vulval drug eruptions. We aimed to establish the extent of drug reactions affecting the vulva, identify the common culprit drugs, and review current evidence and guidelines regarding their management. The vulval involvement seen in Steven-Johnson syndrome, toxic epidermal necrolysis and fixed drug eruption forms the focus of this review, but we also summarize the current evidence regarding less common reactions.

British Association of Dermatologists national clinical audit on the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults.

BACKGROUND: UK guidelines for managing adults with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), published by the British Association of Dermatologists (BAD) in 2016, outline a set of audit standards. OBJECTIVES: To audit current management of SJS/TEN in adults against standards in the BAD guidelines. METHODS: BAD members were invited to submit data on five consecutive adults with SJS/TEN per department over an 8-week period in 2022. RESULTS: Thirty-nine dermatology centres in the UK (29%) participated, and data for 147 adults with SJS/TEN were collected. Within 24 h of the diagnosis being made or suspected, the following were documented, per 147 submitted cases: Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) for 76 (52%), list of medications for 113 (77%) and timelines for commencement/alterations of medications for 104 (71%). The initial assessment was documented of the eyes by an ophthalmologist in 71 (48%), of the mouth in 130 (88%), of the genital skin in 103 (70%) and of the urinary tract in 93 (63%). During the first 10 days after a suspected or confirmed diagnosis of SJS/TEN, daily assessments of the mouth were documented in 26 of 147 cases (18%), of the eyes in 12 (8%), and of the urinary tract and genital skin in 14 (10%). At discharge, a drug was declared to be the cause of SJS/TEN for 130 of 147 cases (88%), while 9 (6%) were thought to be secondary to infection. Eleven of 147 (8%) had no response to this question. Documentation regarding advice was present on avoidance of the culprit drug in 76 of 130 declared SJS/TEN cases (58%), and on requesting a MedicAlert® bracelet/amulet in 9 of the 147 cases (6%). CONCLUSIONS: This audit suggests that a clinical review checklist might be needed to enable colleagues to maintain standards outlined in the guidelines, including documentation of SCORTEN, daily assessments of mucosal areas, and advice to avoid culprit drug(s) and to request a MedicAlert® bracelet/amulet.

Queers in quarantine: Young LGBTQ+ people's experiences during the COVID-19 pandemic in Sweden.

The COVID-19 pandemic led to major restrictions of everyday life activities. This worsened the social situation of many people, and marginalized groups have been especially affected. This article explores how LGBTQ+ young adults in Sweden have been affected by the COVID-19 pandemic and the subsequent recommendations and restrictions. Fifteen participants between 20-29 years, who self-identified as lesbian, gay, bisexual, transgender, and queer (LGBTQ+), were interviewed about their experiences. A thematic analysis of the data showed that the participants perceived their psychological wellbeing to have been greatly affected by the pandemic. Several reported symptoms of clinical depression, as well as anxiety, worry, rumination, and a heightened sensitivity to stress. Stressors included fear of the disease itself, and fear of spreading the virus, as well as the negative consequences of adhering to the recommendations of social distancing, which constantly interplayed with the marginalized position of being a young LGBTQ+ person. Most participants experienced a decrease in minority stress in face-to-face interaction with social distancing measures in place, but an increase in minority stress online. Those who faced minority stress at home experienced the isolation as particularly stressful. Limited access to the LGBTQ+ community was a common stressor. For transgender participants, the effects on transgender healthcare, such as prolonged waiting times for gender dysphoria assessment and hormone treatment, were a major challenge. Our results have added valuable knowledge to research indicating how vulnerable young adults were highly affected by the COVID-19 pandemic restrictions.

Clinicopathological characteristics of individuals with coexisting melanoma and chronic lymphocytic leukaemia: a multicentre cohort study.

BACKGROUND: Individuals with a prior diagnosis of chronic lymphocytic leukaemia (CLL) have a higher risk of developing melanoma and exhibit poorer outcomes than patients without CLL. However, there are limited data reporting the clinicopathological features of melanoma diagnosed in patients with CLL. AIMS: To review clinicopathological characteristics of patients with coexisting diagnoses of melanoma and CLL. METHODS: A retrospective review was undertaken for patients with coexisting diagnoses of melanoma and CLL between 2005 and 2015 in 11 centres in the UK and Ireland. RESULTS: Overall, 46 cutaneous melanomas identified in 45 patients were included. In 28 (62.2%) patients, melanoma was diagnosed after an existing diagnosis of CLL. In this group, mean Breslow thickness was 2.7 mm (range 0.2-25 mm). Ten patients (35.7%) developed locoregional recurrence and 8 (28.6%) developed distant metastases. Melanoma-specific mortality was 5 of 28 (17.9%) and all-cause mortality was 13 of 28 (46.4%). In 17 patients, melanoma was diagnosed before CLL. In this group, mean BT was 2.9 mm (range 0.4-14 mm); five patients (29.4%) developed locoregional recurrence and three (17.6%) developed distant metastases. Melanoma-specific mortality was 1 of 17 (5.8%) and all-cause mortality was 5 of 17 (29.4%) in this group. CONCLUSIONS: To our knowledge, this is the first and largest cohort study to report clinicopathological data of coexisting melanoma and CLL in the UK and Ireland. Although the thickness of primary melanoma was not different before or after a CLL diagnosis, melanoma recurrence and melanoma-specific mortality appear to be more common in patients with a prior diagnosis of CLL.

Adoptive Gay Father Families: A Longitudinal Study of Children's Adjustment at Early Adolescence.

Findings are presented from the second phase of a UK longitudinal study of 33 gay father, 35 lesbian mother, and 43 heterosexual parent families when their adopted children reached early adolescence. Participants predominantly lived in urban/suburban areas and were mostly white and well-educated. Standardized interviews, observations, and questionnaires of parental mental health, parent-child relationships, and adolescent adjustment were administered to parents, children, and teachers between 2016 and 2018. There were few differences between family types. However, adjustment problems had increased in all family types, with better parenting quality and parental mental health associated with fewer adjustment problems. The findings contribute to adoption policy and practice, and to theoretical understanding of the role of parental gender in child development.

Father-child attachment in adoptive gay father families.

The attachment security of children in 30 gay father families, 29 lesbian mother families and 38 heterosexual parent families was investigated using the Friends and Family Interview (FFI) at the second phase of a longitudinal study. Children in gay father families showed significantly higher levels of secure-autonomous attachment than children in heterosexual parent families, significantly lower levels of preoccupied attachment than children in either lesbian mother or heterosexual parent families, and significantly lower levels of disorganised attachment than children in heterosexual parent families. For children in gay father families, stepwise multiple regression revealed that neither hyperactivity nor emotional symptoms at Phase 1 were predictive of disorganisation at Phase 2. However, when entered alone, Phase 1 emotional symptoms predicted Phase 2 disorganisation. The results indicate that adopted children in gay father families are at least as likely to be securely attached as children in lesbian mother or heterosexual parent families.

Reactions from family of origin to the disclosure of lesbian motherhood via donor insemination.

Most studies of planned lesbian motherhood via donor insemination (DI) have sampled lesbian mothers in individualistic societies where adults have relatively distant connection to their family of origin. Our study examined the experiences of biological and non-biological lesbian mothers in five families who had children through DI after disclosing their motherhood status to their family networks in Portugal, a familistic society. The first theme identified by thematic analysis-"But why do you want to have a child?"-encapsulated the reactions of biological mothers' family of origin to the announcement of motherhood. Disclosure was mostly met by a shocked response in the family, rooted in the belief that lesbian women should not have children. The second theme-"But you weren't pregnant, how is this your child?"-summarized the reactions of non-biological mothers' family of origin to the disclosure of motherhood status as they considered refusing to recognize their grandchild in the absence of biological connection. Prejudice against lesbian-mother family formation was associated with the specific intersection of lesbianism and motherhood, but relationships between the mothers and their families were largely repaired because of familistic values.

Prospective parenting: sexual identity and intercultural trajectories.

This study explored the impact of sexual identity on attitudes towards parenthood among childless individuals from Portugal and the United Kingdom (UK). Compared to heterosexuals, lesbians, gay men and bisexuals were less likely to: desire and intend to have children, be concerned about the prospect of childlessness or perceive children as a source of enrichment. They also anticipated more stigma as parents than did heterosexuals. Compared to UK participants, all Portuguese participants, independent of sexual identity, desired and intended more to have children, were more concerned about childlessness, reported higher levels of parental commitment, anticipated less stigma and expected more social support as parents. Portuguese lesbian, gay and bisexual participants expressed greater desire to have children than did those in the UK. Only in the UK did lesbian, gay and bisexual participants perceive children less as a source of enrichment than did heterosexuals and anticipate negative costs associated with parenting. We concluded that the intersectional influence of different cultural climates on parenting aspirations should be taken into account in future research alongside sexual identity.

Parenting desires, parenting intentions, and anticipation of stigma upon parenthood among lesbian, bisexual, and heterosexual women in Portugal.

We explored parenting desires, parenting intentions, and anticipation of stigma upon parenthood in a sample of 257 self-identified lesbian, bisexual, and heterosexual childfree women in Portugal. No differences between the groups were observed concerning parenting desires. However, lesbian and bisexual women reported lower intentions to have children than their heterosexual counterparts. Although lesbian women considered themselves to have a higher chance of being victims of social stigma as mothers, this was not associated with their parenting desires. Furthermore, younger lesbian women intended to have children to a greater extent than did older lesbian women; relational status did not relate to lesbian women's parenting intentions, desires, or anticipation of stigma. Overall, this study contributes to knowledge about family formation processes among Portuguese women diverse in sexual identity.

Adoptive gay father families: parent-child relationships and children's psychological adjustment.

Findings are presented on a U.K. study of 41 gay father families, 40 lesbian mother families, and 49 heterosexual parent families with an adopted child aged 3-9 years. Standardized interview and observational and questionnaire measures of parental well-being, quality of parent-child relationships, child adjustment, and child sex-typed behavior were administered to parents, children, and teachers. The findings indicated more positive parental well-being and parenting in gay father families compared to heterosexual parent families. Child externalizing problems were greater among children in heterosexual families. Family process variables, particularly parenting stress, rather than family type were found to be predictive of child externalizing problems. The findings contribute to theoretical understanding of the role of parental gender and parental sexual orientation in child development.

Survey of core medical trainees in the United Kingdom 2013 - inconsistencies in training experience and competing with service demands.

There is currently considerable concern about the attractiveness of hospital medicine as a career and experiences in core medical training (CMT) are a key determinant of whether trainees continue in the medical specialties. Little is understood about the quality and impact of the current CMT programme and this survey was designed to assess this. Three key themes emerged. Firstly, the demands of providing service have led to considerable loss of training opportunities, particularly in outpatients and formal teaching sessions. Trainees spend a lot of this service time doing menial tasks and over 90% report that service takes up 80-100% of their time. Secondly, clinical and educational supervision is variable, with trainees sometimes getting little consultant feedback on their clinical performance. Finally, 44% of trainees report that CMT has not prepared them to be a medical registrar and many trainees are put off acute medical specialties by their experiences in CMT.

Female interpersonal dependency: genetic and environmental components and its relationship to depression as a function of age.

OBJECTIVES: Research has shown that female interpersonal dependency is significantly associated with clinical depression but is only marginally related to childhood environmental factors. This study replicates the finding of O'Neill and Kendler that such dependency has a significant genetic component and no shared environmental component and extends this by examining the effect of age and the relationship between interpersonal dependency and depression. METHOD: A genetic model analysis for female twin pairs was made incorporating a scale from the Interpersonal Dependency Inventory, and the association between dependency quartiles and depression for both sexes determined. Dependency data were obtained by questionnaire from 4427 monozygotic and dizygotic twins, 90% female and this was combined with lifetime incidence of depression data in three categories of severity. RESULTS: Additive genetic variance components of 49% and 41% were estimated for those females between 19-64 and 65-87 years, respectively, with no significant effect for the shared family environment for either age group. Only female dependency was found to be associated with the incidence of depression. Incidence levels of severe depression for older females in the highest quartile of dependency were 26% compared to 43% for the younger females. CONCLUSION: The investigation has estimated that nearly half of the variance in female interpersonal dependency is genetic in origin. It has also confirmed that high levels of such dependency are associated with the incidence of severe depression and this effect reduces with age. The possible reasons for this age-related effect are discussed.

Lesbian co-mothers' experiences of maternity healthcare services.

AIM: This article is a report of a study of lesbian co-mothers' experiences of UK maternity healthcare services. BACKGROUND: With the increase in fertility provision to lesbian couples, maternity healthcare services are increasingly coming into contact with lesbian co-mothers. Literature highlights the need to investigate donor-conceived lesbian families and an absence of research focusing on the unique experiences of co-mothers in the maternity process. DESIGN: The study followed a qualitative design and interpretative phenomenological analysis methodology. METHODS: A qualitative study was carried out involving ten lesbian co-mothers, whose children were conceived via anonymous donor insemination to their partners. Data collection took place between May-September 2009. FINDINGS: Interpretative phenomenological analysis revealed two main types of co-mothers' experiences, those connected with maternity service structures and interpersonal experiences with maternity care staff. Co-mothers felt excluded by heterocentric organizational service structures. However, the co-mothers' overwhelming experiences with staff were positive and inclusive. Despite this, co-mothers reported that any ambiguous or non-inclusive experiences with professionals left them questioning whether these experiences were due to homophobic attitudes or professional incompetence. CONCLUSION: The results indicate that these lesbian co-mothers felt predominantly included and accepted by maternity services. Ambiguous interpersonal experiences, however, evoked doubts in this regard. In addition, organizational heterocentric structural barriers remain. Structural service delivery changes could facilitate co-mothers' feelings of inclusion and highlight the important role practitioners have in contributing to co-mothers' experiences.

Psychological Adjustment Profiles of LGBTQ+ Young Adults Residing with Their Parents during the COVID-19 Pandemic: An International Study.

The COVID-19 pandemic has been associated with poor mental health symptoms, particularly among vulnerable populations such as LGBTQ+ individuals. In the present study, we aimed to (i) identify different psychological adjustment profiles among LGBTQ+ young adults during the COVID-19 pandemic and compare LGBTQ+ young adults in relation to (ii) sociodemographic characteristics and COVID-19-related experiences and (iii) the internal and external protective resources associated with each adjustment profile. An online questionnaire was administered to 1699 LGBTQ+ young adults from six countries (Brazil, Chile, Italy, Portugal, Sweden, and the UK). A cluster analysis was conducted, and four profiles of psychological adjustment were identified: unchallenged, resilient, distressed, and at-risk. The at-risk cluster scored lowest in social support (particularly from family). The profiles of participants who experienced the highest levels of pandemic adversity (at-risk and resilient) comprised mostly South American participants, those under lockdown at the time of survey completion, those who self-identified as transgender and non-binary, and those with a plurisexual sexual orientation. Interventions should consider strategies to help young adults maintain support systems and reinforce the value of positive family relationships. Specific groups within the LGBTQ+ community that seem to be in a particularly vulnerable situation may need additional tailored support.

Toward an Understanding of the Experiences of Deaf Gay Men: An Interpretative Phenomenological Analysis to an Intersectional View.

Similarities between developing a deaf identity and a sexual minority identity have been postulated upon the parallel experience of oppressed minority positions. Sign language interviews with eight deaf gay British men explored their intersectional understanding of deaf-gay lived experiences, analyzed through Interpretative Phenomenological Analysis. During their adolescence deaf gay men sometimes experienced being in a position where they were trying hard to be something they were not: oral and heterosexual for hearing non-signing others (including heterosexual members of their family of origin). Participants spoke of increasingly being drawn toward a welcoming signing cultural world that supported them against deaf minority stress. Coming out as gay presented not only potential family of origin difficulties, but also threatened connection with the deaf community, leaving participants intensely fearful of gay visibility and stigma. Self-fulfillment and community building was sought through positions that ranged from oralist-heteronormativity through to the deaf-gay community. Along the way these journeys included experiences of pride and success alongside those of struggle. Our findings extend research on intersectionality by presenting a distinct set of obstacles, caveats, and nuances to identity conjunction.

The Prospective Co-Parenting Relationship Scale (PCRS) for Sexual Minority and Heterosexual People: Preliminary Validation.

The coparenting relationship begins with a process of planning and negotiation about having children. Available psychological instruments have not been adapted to sexual minority people, which compromises their ecological validity. This mixed method study aimed to adapt and validate a prospective version of the Co-Parenting Relationship Scale in a Portuguese sample of sexual minority and heterosexual adults who did not have children and who were in a dyadic relationship. In study 1, cognitive interviews were used to gather participants' reflections about the original items and the role played by the family of origin and anticipated stigma in coparenting (n = 6). In study 2, using a sample of individuals from 18 to 45 years old, two Exploratory Factor Analyses (EFA) were conducted separately for sexual minority (n = 167) and heterosexual persons (n = 198), and a Confirmatory Factor Analysis (CFA) was conducted for heterosexual persons (n = 176). Results showed underscored the importance of families of origin independent of sexual orientation. Different factorial structures for sexual minority and heterosexual persons were observed. Among sexual minority persons, the role of stigma was also highlighted. Implications for practice and research are discussed.

Key stakeholder perspectives on expert-by-experience involvement in the values-based recruitment of student mental health nurses: A co-produced qualitative study.

BACKGROUND: Values-based recruitment is a mandatory process for nursing programmes within UK higher education, with the Nursing Midwifery Council expecting that experts-by-experience are engaged in these recruitment and selection processes. The wider involvement of experts-by-experience in healthcare education is gaining momentum internationally with calls for engagement in all aspects of design and delivery; however, the impact of such involvement in recruitment of nursing students has received little attention, particularly in mental health nursing. AIM: To understand the impact of expert-by-experience involvement in the values-based recruitment of mental health nursing students from the perspective of candidates, experts-by-experience, and academic staff. DESIGN AND METHODS: This qualitative approach was co-designed and implemented by a research team comprised of academics, experts-by-experience, and student mental health nurses. Focus groups and an on-line survey were used to collect data, with Burnard's thematic analysis providing a framework for data analysis. SETTING/PARTICIPANTS: This study took place at one UK university. Participants included nurse academics, experts-by-experience, and student nurses with experience of a values-based recruitment process. RESULTS: Thematic analysis identified four themes: starting out, collaboration, rich assessment, and stakeholder gains. Whilst not without its challenges, the involvement of experts-by-experience in the recruitment of mental health nursing students was identified as delivering a robust recruitment process, encompassing academic abilities alongside the personal qualities required to make a 'good nurse'. Personal benefits for experts-by-experience, candidates, and academics were also reported. CONCLUSION: This study provides insights into the impact of experts-by-experience in supporting values-based recruitment. The approach is identified as enhancing the selection process by drawing from academic and lived experience perspectives and highlights to potential candidates, at the outset of their career, the value of meaningful engagement. These findings support the Nursing Midwifery Council's position that experts-by-experience should be engaged in the recruitment and selection of student nurses.

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19.

People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

Exploring Lesbian and Bisexual Catholic Women's Narratives of Religious and Sexual Identity Formation and Integration.

Many LGBT people with a Christian upbringing experience conflict between their religious and sexual identities. Many resolve this conflict by leaving Christianity, others by moving to affirming churches. Some research has examined the experiences of LGBT people who choose to attend conservative churches; however, there has been very little research on the experiences of non-heterosexual women in the Catholic Church. Narrative and thematic analyses of data collected through qualitative interviews with six non-heterosexual Catholic women revealed several ways participants had integrated their faith and sexuality: acceptance from other Catholics, distinguishing between the Church and God, meeting other LGBT Christians, and developing a personal relationship with God. These reflect strategies adopted by gay Catholic men and LGBT Christians attending Protestant churches. Nonetheless, participants reported that their experiences varied from those of gay Catholic men due to gay men being more visible and more subject to prejudice within the Church.