Factors associated with various strategies for maintaining sexual activity after prostate cancer treatment.

Many men experience sexual difficulties after receiving prostate cancer treatment. We investigated sexual and relationship factors associated with management strategies to maintain sexual activity in prostate cancer patients. 210 prostate cancer patients (66.7 ± 7.4 years old) completed our survey online. Higher sexual function distress (Incidence rate ratio, IRR = 0.99, p = 0.005) and less frequent relationship strain (IRR = 1.01, p = 0.002) were associated with trying a higher number of sexual management strategies. Higher sexual function distress was associated with the use of oral medication (Odds Ratio, OR = 0.98, p = 0.026), vacuum erection device (OR = 0.98, p = 0.005), and vibrators (OR = 0.97, p = 0.005). Perceived importance of sexual interaction with a partner was associated with using oral medication (OR = 1.95, p = 0.027). Participant's higher ideal frequency of sexual interaction with a partner was a predictor for the use of vibrators (OR = 1.03, p = 0.024). Less frequent relationship strain was associated with the use of vacuum erection device (OR = 1.03, p = 0.002), and vibrators (OR = 1.02, p = 0.012). Lastly, patients' communication with their partner about sexual intimacy was also associated with use of vacuum erection device (OR = 3.24, p = 0.050, CI 1.0-10.5). Few participants (13-27%) were interested in trying penile implant, penile support device, external penile prosthesis, penile sleeve and anal devices. From our qualitative analyses, the main barriers to retaining sexual activity were erectile dysfunction and psychological issues. Three themes participants found useful to maintain sexual activity: preparatory behaviours for initiating or maintaining erections, adapting their sexual activity to fit with what was now possible, and the importance of the relationship or intimacy with their sexual partner. Psychological and relationship factors contribute to patients' motivation to remain sexually active after treatment.

Psychosocial Barriers and Enablers for Prostate Cancer Patients in Starting a Relationship.

Single prostate cancer (PCa) patients may face difficulties in starting a new relationship for various reasons. Here, we studied barriers and enablers to starting a relationship for PCa patients and characteristics of patients who were and were not in a relationship. PCa organizations distributed for us a 20-minute online survey, consisting of validated questionnaires (on treatment side effects, loneliness, social provision, and shyness) and questions on factors identified by patients as barriers and enablers to forming a new relationship. Participants were either single [n = 20] or had started a new relationship post-diagnosis [non-single, n = 15]. Three factors-confidence, sexual function, finding the right person-were perceived of as factors that can affect starting a relationship. Fourteen of twenty single patients were confident that they could find a partner and sixteen were comfortable in disclosing their cancer diagnosis to a potential partner. Non-single patients met their partners through various ways, including online dating and social events. They all revealed their cancer status prior to starting the relationship, and most partners reacted well to this disclosure. Single patients were lacking emotional support, more shy, and lonelier than non-single patients. Clinicians need to consider biopsychosocial factors when advising single patients who wish to start a new relationship.

Maintenance of sexual activity following androgen deprivation in males.

Androgen deprivation therapy (ADT) is a common treatment for men with systemic prostate cancer. However, ADT leads to sexual dysfunction, causing >80 % of couples to cease sexual activity completely. Here, we use a biopsychosocial framework to review factors that may influence the ability of patients on ADT to remain sexually active. We address sexual factors prior to ADT, neurobiological factors, intermittent ADT, sex aids, exercise, sleep, partner factors, masculinity, non-penetrative intimacy, depressive symptoms, and access to counselling or patient education programs. We make suggestions for future research in order to extend our understanding in this field with the goal of improving evidence-based treatment protocols and practice. Importantly, we suggest that clinicians should discuss options for sexual intimacy after ADT with both patients and their partners, as sexual inactivity is not inevitable for most, and strategies are available for helping maintain sexual intimacy.

The effect of postprandial glycaemia on cognitive function: a randomised crossover trial.

The effect on cognitive test scores of generating differences in postprandial glycaemia using test foods or beverages has been inconsistent. Methodological issues may account for some of the variable results requiring further investigation using strong study designs into the relationship between glycaemia and cognitive functioning. The objective of this study was to determine the effects of postprandial glycaemia on cognitive function by examining cognition after consumption of foods that differ only by the rate of digestion of available carbohydrate in a population of young adults. In a double-blind, randomised, crossover trial, sixty-five participants received trifle sweetened either with a higher-glycaemic index (GI) sugar (sucrose; GI 65) or a lower-GI sugar (isomaltulose; GI 34). Cognitive tests were completed prior to trifle consumption, and 60 and 120 min after. There was no between-trifle difference at 60 min in performance on free word recall (0·0 (95 % CI -0·6, 0·5)), short delay word recall (0·0 (95 % CI -0·5, 0·5)), long delay word recall (0·0 (95 % CI -0·6, 0·6)), letter-number sequence recall (0·3 (95 % CI - 0·2, 0·7)) and visuo-spatial recall (-0·2 (95 % CI -0·6, 0·2)) tests. At 120 min, no difference was detected in any of these tests. The participants performed 7·7 (95 % CI 0·5,14·9) s faster in Reitan's trail-making test B 60 min after the higher-GI trifle than the lower-GI trifle (P = 0·037). Our findings of a null effect on memory are generally consistent with other works in which blinding and robust control for confounding have been used.

Investigating the care needs of those with endometriosis: Are we listening to the patients?

What do women with endometriosis need? What are the things that would make their lives easier? Where are the gaps in their care? Questions like these can only be answered by women themselves. The development of an unmet needs survey for women with endometriosis would facilitate the design of patient-centred interventions to meet these needs and ultimately improve quality of life.

Transitions Through Stages of Alcohol Use, Use Disorder and Remission: Findings from Te Rau Hinengaro, The New Zealand Mental Health Survey.

AIMS: To understand transitions from alcohol use to disorder, we examine timing of transitions between stages of alcohol use and associations between transitions and socio-demographic factors. SHORT SUMMARY: Using nationally representative data, we found that the majority of alcohol use disorders develop by age 25. Increased alcohol use within a participant's cohort was associated with subsequent transition across all stages of alcohol use and disorder. Fifty percent of dependence cases had not remitted after 9 years. METHODS: A nationally representative sample with a 73% response rate included 12,992 participants aged 16 and older. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess age at initial alcohol consumption, commencement of regular consumption, symptoms of alcohol abuse and dependence, and year-long remission. Alcohol consumption in an age- and gender-matched cohort, education, gender and age at commencement of use were investigated as covariates. RESULTS: Among all respondents, 94.6% used alcohol, 85.1% used alcohol regularly, 11.4 and 4.6% had developed alcohol abuse and dependence disorders, respectively. Of those with an abuse or dependence disorder, 79.9 and 67.2% had remitted, respectively. Increased alcohol use within a participant's cohort was associated with subsequent transition across all stages. The majority of disorders had developed by age 25. Considerable time was spent with disorder; 50% of dependence cases had not remitted after 9 years. Men were at greater risk of disorder and less likely to remit. CONCLUSIONS: Interventions should target young people and cohort-specific consumption with resources also allocated to long-term treatment provision for alcohol dependency.

Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study.

BACKGROUND: We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood. METHODS: Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria. RESULTS: There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age. LIMITATIONS: Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years. CONCLUSIONS: Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations.

Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers.

AIMS: To investigate inclusion of sexuality and gender identity content, attitudes and barriers to inclusion of content in preclinical curricula of New Zealand medical schools from the perspective of key teaching staff. METHOD: Staff responsible for curriculum oversight at New Zealand's two medical schools were invited to complete a mixed-methods survey about sexuality and gender identity content in their modules. RESULTS: Of 24 respondents, the majority included very little content relating to sexuality or gender identity (33%) or none at all (54%). This content was deemed important by most participants (69%), and none believed there should be less such content in their curriculum. Time was reported to be the main barrier limiting inclusion of such content. CONCLUSIONS: Our finding of limited content is consistent with international literature. Our findings extend the literature by revealing that barriers to greater inclusion of content are not due to overt negative attitudes. Staff responsible for preclinical medical curriculum oversight have positive attitudes about content relating to sexuality and gender identity but perceive curriculum space to be a limiting barrier. This is important as it informs approaches to change. Future interventions with medical schools should focus on methods to increase diverse content as part of existing teaching, education to increase knowledge of LGBTQI relevant material and potentially incorporate strategies used to address unconscious bias. Addressing the perceived barriers of time constraints and lack of relevance is required to ensure medical students receive training to develop the competencies to provide positive healthcare experiences for all patients regardless of sexuality and gender identity.

Associations between DSM-IV mental disorders and subsequent COPD diagnosis.

OBJECTIVES: COPD and mental disorder comorbidity is commonly reported, although findings are limited by substantive weaknesses. Moreover, few studies investigate mental disorder as a risk for COPD onset. This research aims to investigate associations between current (12-month) DSM-IV mental disorders and COPD, associations between temporally prior mental disorders and subsequent COPD diagnosis, and cumulative effect of multiple mental disorders. METHODS: Data were collected using population surveys of 19 countries (n=52,095). COPD diagnosis was assessed by self-report of physician's diagnosis. The World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) was used to retrospectively assess lifetime prevalence and age at onset of 16 DSM-IV disorders. Adjusting for age, gender, smoking, education, and country, survival analysis estimated associations between first onset of mental disorder and subsequent COPD diagnosis. RESULTS: COPD and several mental disorders were concurrently associated across the 12-month period (ORs 1.5-3.8). When examining associations between temporally prior disorders and COPD, all but two mental disorders were associated with COPD diagnosis (ORs 1.7-3.5). After comorbidity adjustment, depression, generalized anxiety disorder, and alcohol abuse were significantly associated with COPD (ORs 1.6-1.8). There was a substantive cumulative risk of COPD diagnosis following multiple mental disorders experienced over the lifetime. CONCLUSIONS: Mental disorder prevalence is higher in those with COPD than those without COPD. Over time, mental disorders are associated with subsequent diagnosis of COPD; further, the risk is cumulative for multiple diagnoses. Attention should be given to the role of mental disorders in the pathogenesis of COPD using prospective study designs.

Age, quality, and context of first sex: associations with sexual difficulties.

INTRODUCTION: Research consistently indicates an association between a younger age at first sex and poorer sexual health outcomes. However, research addressing associations between age at first sex and sexual difficulties has produced mixed findings. Moreover, little is known about links between the context and quality of first sex and subsequent sexual difficulties. AIMS: The aims of this study are to examine whether (i) age and (ii) context and quality at first sex are associated with sexual difficulties; (iii) examine whether age at first sex and context and quality variables are independently associated (after mutual adjustment) with sexual difficulties; and (iv) examine whether age at first sex has an indirect effect on sexual difficulties through an effect on context or quality. METHODS: Data from 388 questionnaires were gathered from students aged 17-21 living in accommodation halls and by postal invitation to adults aged 25-35. MAIN OUTCOME MEASURES: The main outcome measure was the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), which assesses sexual difficulties via an overall score and seven subscales. RESULTS: Appraising first sex as emotionally negative was associated with the majority of sexual difficulties. A less stable relationship at first sex was associated with sexual communication problems and dissatisfaction. Greater enjoyment and using substances were associated with a lower likelihood of anorgasmia for women. Age at first sex was directly associated with reduced sexual frequency only. A younger age at first sex was associated with a greater likelihood of negative appraisal and lower likelihood of a stable relationship and thereby indirectly associated with several sexual difficulties. CONCLUSIONS: Experiencing first sex as emotionally negative was consistently associated with later sexual difficulties. When attending to sexual difficulties, understanding the quality and context of first sex may be more useful than knowing the age at first sex. This research is limited by the retrospective nature of the reports of first sex.