Unmet sexual health needs of young men in contemporary society regarding condom use: Qualitative study.

OBJECTIVE: In contemporary societies young men receive much misleading information about sex from friends, the media and the internet (porn) which can make them feel insecure and under pressure regarding sex. The purpose of this study is therefore to understand their sexual world better and learn about their sexual health needs, especially regarding condom use. METHODS: The study is based on two qualitative studies: focus groups and individual interviews. Recruitment of participants took place through schools, a Sexually Transmitted Infection (STI) Clinic and a Gay and Lesbian Organisation. The interviews were thematically analysed using the framework method. RESULTS: Forty-nine individuals, 18-25 years old, participated in both studies. The findings showed that the participants had a number of unmet needs regarding condom use which reduced this use. They described uncertainty regarding condom use by not prioritising them, showing lack of knowledge and communication skills. It was of high priority for them to seek sexual pleasure and not be disturbed in the process of having sex. CONCLUSIONS: The results suggest that young men have a great need to perform sexually and not to fail. This need represents insecurity in a sexual relationship. When insecurity, inability to communicate and feeling under pressure come together using a condom is not prioritised. These young men are in great need of holistic sex education that would enable them to become secure in mastering condom use.

"You stop thinking about yourself as a woman". An interpretive phenomenological study of the meaning of sexuality for Icelandic women during pregnancy and after birth.

OBJECTIVE: There exists considerable evidence about reduced sexual desire and sexual disorders during pregnancy and after giving birth. More in-depth qualitative evidence is needed. The purpose of this study was to find out how Icelandic women experienced their sexuality during pregnancy and after giving birth. DESIGN/SETTING: An interpretive phenomenological study based on individual interviews with eight women was carried out at two time points, six and 12 months after giving birth, giving a total of 16 interviews. Women who had given birth at Landspitali - The National University Hospital of Iceland were selected for the study through purposeful sampling. The interviews were audio-recorded and transcribed verbatim. The text was analysed by using interpretive phenomenology. FINDINGS: Changes during pregnancy and the post-partum period affected how the women perceived themselves as sexual beings. They expressed a great need for physical and emotional intimacy during this time. Their needs for physical intimacy did not necessarily include the desire for sexual intercourse. How well their needs were met by their partner depended apparently on how intimate their relationship was. The relationship either tilted towards balance or imbalance, more towards balance when intimacy needs were taken care of. Communication, being emotionally close to the partner, and how the partner showed consideration played a great role in their sexual relationship. KEY CONCLUSIONS: During these transitional times women felt differently as sexual beings, they had great need for emotional and physical intimacy, and needed to share their thoughts, to be close and to be appreciated. IMPLICATIONS FOR PRACTICE: Health care professionals, especially midwives and nurses, could contribute to the balance in the relationship through the provision of evidence-based information about normal changes in sexual behaviour during the childbearing process and by discussing intimacy issues. The partner may need this information as much as the woman.

Personal resurrection: female childhood sexual abuse survivors' experience of the Wellness-Program.

BACKGROUND: Childhood sexual abuse (CSA) survivors deal with complex mental, physical and relationship problems in adulthood which negatively affects their well-being and health. The aim of the present paper was to present a description of the Wellness-Program for female CSA survivors, the participating women's evaluation of the different therapies in the program as well as a qualitative study on their experience of the program's effects on their life, health and well-being. METHOD: The Wellness-Program lasted for 10 weeks with organised schedule 20 hours per week. A team of health professionals used a holistic approach and provided traditional and complementary individual and group therapy focusing on both mind and body. In-depth phenomenological interviews with ten women, 22-53 years old, were conducted 1 week before and 1 week after the program as well as 15 months later. Data collection and data analysis were guided by the Vancouver School of doing phenomenology. RESULTS: Prior to participating in the program, the women were unable to work or attend school, were on disability allowance, were socially isolated and had complex health problems. After the Wellness-Program, all the women, except one, were back to work, school or in further rehabilitation. Furthermore, the in-depth interviews showed that their health and well-being, personal life and relationship with partners, family and friends improved. They felt empowered, more in control and had developed increased trust towards others. Six themes were constructed from the in-depth interviews. They were: feeling totally lost, releasing experiences, developing trusting relationships, gaining control, experiencing positive changes in physical and mental health and, finally, feeling of empowerment. The overriding theme of the study was personal resurrection. CONCLUSIONS: The Wellness-Program contributed considerably to improved health and well-being of the women. However, further assessment of the program is recommended before making it available within the healthcare system.

Consequences of childhood sexual abuse for health and well-being: gender similarities and differences.

AIMS: Analyse gender similarities and differences in the consequences of childhood sexual abuse for health and well-being. METHODS: Comparative analysis of 28 in-depth interviews with 14 purposefully chosen participants, seven women and seven men, who had experienced childhood sexual abuse; two interviews were conducted with each participant. RESULTS: The participants expressed a journey of deep and silent suffering which seems, for them, to be endless and almost unbearable. All of them have suffered from complex health problems since childhood. A gender difference was shown in the tendency of women to internalize their emotional pain while the men had a tendency to externalize it. CONCLUSIONS: It is important for health professionals to be aware of the symptoms and consequences of child sexual abuse in order to provide support, appropriate care and treatment for the survivors. Finally, preventive and long lasting public health measures have to be taken in order to prevent children from experiencing such serious trauma.

Effects of pesticides and pharmaceuticals on biofilms in a highly impacted river.

We investigated the effects of pharmaceuticals and pesticides detected in a Mediterranean river, on fluvial biofilms by translocation experiments performed under controlled conditions. Water was sampled from three sites along a pollution gradient. Biofilms grown in mesocosms containing relatively clean water were translocated to heavily polluted water. Several biofilm descriptors were measured before and after translocations. Fifty-seven pharmaceuticals and sixteen pesticides compounds were detected in river waters. The translocation from less to more polluted site was the most effective. Autotrophic biomass and peptidase increased while phosphatase and photosynthetic efficiency decreased. Multivariate analysis revealed that analgesics and anti-inflammatories significantly affected biofilm responses. Ibuprofen and paracetamol were associated with negative effects on photosynthesis, and with the decrease of the green algae/cyanobacteria ratio, while diclofenac was associated with phosphatase activity. The effects of these emerging compounds on biofilms structure and function may cause important alterations in river ecosystem functioning.

Content analysis: a review of perceived barriers to sexual and reproductive health services by young people.

OBJECTIVES: Barriers to youth sexual and reproductive health (SRH) services have not been researched extensively. The purpose of this content analysis was to explore barriers as perceived by young people. METHODS: A review of empirical studies regarding barriers impairing access to and utilisation of SRH services as perceived by 10- to 25-year-olds was conducted. The studies, published between 2000 and 2010, utilised qualitative and quantitative methods. Data were analysed using inductive content analysis. RESULTS: Seventeen studies were singled out for evaluation from the 189 articles and reports gathered. Content analysis of barriers identified three categories of barriers that were directly related to the services plus a central category labelled 'personal factors'. The latter included young people's perceptions of service access, service entry, and quality of services, for all of which confidentiality and the fear of a ruined reputation were most important. CONCLUSIONS: This content analysis shows how personal the whole process, from accessing the service to the end of the visit, is for the young person. To make SRH services more appealing to young people these barriers to services need to be recognised and reduced.

Phosphorus use by planktonic communities in a large regulated Mediterranean river.

The regulation of large rivers to meet human requirements (e.g. hydroelectricity production, flood prevention, recreation activities) alters the longitudinal distribution of plankton communities and may affect their capacity to use nutrients and organic matter. Here we analyzed phosphorus (P) availability and use by phytoplankton and bacterioplankton in 6 upstream and 5 downstream sites from a reservoir system in the Ebro River (N Spain). Alkaline phosphatase activity (APA) was related to nutrient availability and biomass of both phytoplankton and bacterioplankton. During dry periods phytoplankton and bacterioplankton APA was inversely correlated to P availability in the water, but these patterns became less clear during wet periods. The phosphorus-APA patterns were more consistent in the upstream sites and especially during dry periods. Although phytoplankton APA was 6-40 times greater than that of bacterioplankton, APA per unit of biomass suggested that bacterioplankton was more efficient at utilizing dissolved organic phosphorus (DOP) in the upstream section during dry periods. Imbalanced N:P ratios in the particulate (N:P ranging 133-170) and dissolved (N:P ranging 301-819) water fractions confirmed the strong P limitation in these upstream communities. The phosphorus-APA patterns were weaker in the downstream section and during wet periods. The reservoirs caused a change in the downstream dynamics, where bacterioplankton biomass was positively correlated to APA but APA per unit of biomass decreased. Our findings reveal that river regulation drives changes in plankton use of organic phosphorus, especially during extreme dry periods.

Deep and almost unbearable suffering: consequences of childhood sexual abuse for men's health and well-being.

Previous studies indicate that childhood sexual abuse can have extensive and serious consequences. The aim of this research was to do a qualitative study of the consequences of childhood sexual abuse for Icelandic men's health and well-being. Phenomenology was the methodological approach of the study. Totally 14 interviews were conducted, two per individual, and analysed based on the Vancouver School of Phenomenology. The main results of the study showed that the men describe deep and almost unbearable suffering, affecting their entire life, of which there is no alleviation in sight. The men have lived in repressed silence most of their lives and have come close to taking their own lives. What stopped them from committing suicide was revealing to others what happened to them which set them free in a way. The men experienced fear- or rage-based shock at the time of the trauma and most of them endured the attack by dissociation, disconnecting psyche and body and have difficulties reconnecting. They had extremely difficult childhoods, living with indisposition, bullying, learning difficulties and behavioural problems. Some have, from a young age, numbed themselves with alcohol and elicit drugs. They have suffered psychologically and physically and have had relational and sexual intimacy problems. The consequences of the abuse surfaced either immediately after the shock or many years later and developed into complex post-traumatic stress disorder. Because of perceived societal prejudice, it was hard for the men to seek help. This shows the great need for professionals to be alert to the possible consequences of childhood sexual abuse in their practice to reverse the damaging consequences on their health and well-being. We conclude that living in repressed silence after a trauma, like childhood sexual abuse, can be dangerous for the health, well-being and indeed the very life of the survivor.

Three cases of adolescent childbearing decision-making: the importance of ambivalence.

Limited information is available about the childbearing decision-making experience by the pregnant adolescent. The purpose of this case study was to explore this experience with three pregnant teenagers. The study is based on nine qualitative interviews. Within-case descriptions applying the theoretical model of decision-making regarding unwanted pregnancy and across-case findings are presented. The results showed that considerably more ambivalence was described than suggested by the authors of the model. The findings also indicate that there was considerable ambivalence about motherhood. The childbearing decision was rather passive for two of the girls while the oldest girl more actively considered the alternatives of abortion and childbearing. The oldest girl experienced more ambivalence than the other girls which seemed beneficial for her. Fear of feeling regret later on mainly guided the decision of the girls toward not having an abortion. That decision left them with the other alternative, having the child, since adoption was never an option. None of them was ready for motherhood. After two of them had been assured of support, they seemed to be willing to follow a new direction in their lives. Further qualitative exploration of ambivalence in childbearing decision-making among adolescents is necessary in order to determine the factors which can contribute to more decisive decision-making and probably lead to less regret afterwards. Such information may also be of benefit in sex education courses and in counseling pregnant girls.

Teenage contraceptive use in Iceland: a gender perspective.

Different gender beliefs toward contraception may affect contraceptive use among teenagers and need to be explored for the development of sexuality education and services aimed at this age group. A cross-sectional national survey was conducted. A random sample of 1,405 sexually active teenagers, 1,181 girls, and 224 boys was studied. One quarter of the girls and one fifth of the boys had often/always used unsafe methods (withdrawal and natural methods), and about one third of the teenagers used contraceptive methods sporadically or not at all. Generally, teenage girls had more positive beliefs toward use of contraceptives, more positive friends, and more supportive parents regarding contraception than boys. Both genders were more likely to use contraceptives if they recognized the seriousness of pregnancy and easiness of making contraceptive plans. Additionally, teenage girls were more likely to use contraceptives if they were older at the time of sexual debut, were in a steady sexual relationship, considered contraceptive services good, believed in not taking chances, and their parents knew about their contraceptive use. Preventive strategies must primarily target those teenagers who start sexual debut early, are not in a steady relationship, and are not receiving parental support.

Effectiveness of preabortion counseling on postabortion contraceptive use.

In a randomized trial, the effect of preabortion counseling was evaluated and contraceptive use postabortion described. The 420 women, who were assigned into either an intervention group (n = 210) or a control group (n = 210), were followed-up 4-6 months later, a total of 148 and 128 women in each respective group. No significant difference was found between the two groups regarding contraceptive use after abortion (86%, 85%), which indicates no immediate intervention effect. The women, in both groups, who had previously undergone abortion were less likely to use contraception. The main contraceptive methods used by intervention and control groups were oral contraceptives (61% and 58%, respectively) and injectables (12% and 11%). Choice of method was mainly based on women's prior perception of effectiveness and convenience of use. A majority of the women in both groups could not specify their contraceptive plans. A postrandomization inequality regarding age, education and parity in the two groups had, however, to be taken into account. Intensive contraceptive counseling before abortion may not be effective, but those who are at higher risk of unplanned pregnancy need special attention.

Comparison of four different suture materials in soft tissues of rats.

OBJECTIVES: The purpose of this in vivo study was to histopathologically evaluate the inflammatory reaction incited by Vicryl in rats and compare this material with various suture materials that are widely used in the clinic. SUBJECTS AND METHODS: Four different suture materials, catgut, silk, polypropylene, and Vicryl were used in soft tissues of 32 Sprague-Dawley rats. Incisions performed were sutured by a standard technique. Eight rats were killed at the first, third, fifth, and seventh days. Histopathological evaluation of the en bloc samples was performed by determining the density of seven cell-types. A numerical grading from one to three was used. The data were statistically analysed by Kruskal-Wallis one way ANOVA and Dunn's tests. RESULTS: Vicryl has produced the mildest tissue reaction among the test materials at all experimental periods (P<0.05). Total cell number value in Vicryl group was found to be significantly lower than the one in catgut group (P<0.05). CONCLUSION: Under the conditions of this study, the results demonstrated that Vicryl as a suture material produced the mildest tissue reaction during early healing period.

Induced abortion in the Nordic countries: special emphasis on young women.

BACKGROUND: To analyze the trends in legally induced abortions among women younger than 30 years in the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden, since the liberalized abortion laws came into force. METHODS: Data stem from national registrations of vital events. Some have been published in the national vital statistics while others have been retrieved for this study. General and age-specific abortion rates are used to analyze the trends. Further, an index has been calculated by dividing the age-specific abortion rates by the Nordic average. RESULTS: The analysis reveals an overall reduction in the general abortion rates in the Nordic countries, apart from Iceland. The rates have been highest in Denmark and Sweden and lowest in Finland since the early 1980s. In the mid-1980s, the abortion rates increased among 15-19-year-old women in Sweden and among 20-24-year-old women in Denmark, Norway and Sweden, followed by a reduction. In Iceland the very low age-specific abortion rates for all age groups under 30 years at the beginning of the study period increased and Iceland had the highest rate for 15-19-year-old women in the late-1990s. CONCLUSIONS: The relatively low abortion rates in Finland demonstrate effective preventive efforts, although the recent increase challenges further studies on the relationship between abortion rates and counseling activities. The rise in abortion rates in Iceland indicate a need for improved sex education, contraceptive services and availability of contraceptive methods for young people.

Fasceitis necrotizante y celulitis asociada a sepsis: distintas fases de una misma enfermedad / Fasciitis Necrotizing and associated cellulitis to sepsis: different stages of the same disease

Considerando la mayor agresividad que ha sido reportada en infecciones por Estreptococo beta Hemolítico del Grupo A decidimos efectuar una revisión de los casos ocurridos durante 1994 en nuestra institución. Revisamos aquellos casos reportados como Fasceitis Necrotizante o Celulitis Asociada a Sepsis durante dicho período. Encontramos un total de 8 casos, 6 de los cuales fallecieron. En 4 se aisló Estreptococo beta Hemolítico del Grupo A. Por lo regular los pacientes padecían de alguna enfermedad como diabetes Mellitus o insufiencia cardíaca u otra condición que los inmunodeprimiera. De manera interesante 3 de los pacientes que fallecieron fueron diagnosticados como celulitis e ingresados a un servicio en donde horas después desarrollaron el cuadro de necrosis y sepsis, todos estos fallecieron debido a lo poco agresivo del tratamiento inicial. Sólo 2 pacientes recibieron penicilina como primera droga. Concluímos en que la fasceitis necrotizante es una enfermedad que debe considerarse en aquellos casos que se presenten como celulitis sin necrosis pero que exista algún dato clínico de sepsis o alguna enfermedad que disminuya la respuesta inmune del enfermo. Dichos casos deben tratarse en unidades de cuidados intensivos

Relación entre infecciones de valvulas de derivación ventrículo-peritoneal y uso de ceftriaxona profiláctica: estudio retrolectivo, Hospital General San Juan de Dios / Relation between ventricular-peritoneal valvels shunt and the use of prophylactic ceftriaxone

Se revisaron durante 1994 todos los casos de meningitis ocurridos en el servicio de Neurocirugía de Adultos del Hospital General San Juande Dios. Se encontraron 10 casos de meningitis en un total de 61 válvulas colocadas (12.35). En 50 de los casos el germen fue único, en 20 se aislaron dos microorganismos y en 30 tres. El germen más frecuentemente aislado fue Staphilococcus coagulasa negativo en 6 casos seguido por K. Ozanae en 3 casos. Encontramos asociación entre el desarrollo de infección y el tiempo quirúrgico y además en el uso de ceftriaxona profiláctica. Concluimos en que el riesgo de infección de estos dispositivos es alto en nuestra institución, las medidas de asepsia y antisepsia deben revisarse, lo mismo con respecto al tiempo quirúrgico y además el uso profiláctico de cefalosporinas de tercera generación debe suprimirse de dichas cirugías