Does One Size Fit All? Socioeconomic Moderators of Post-divorce Health and the Effects of a Post-divorce Digital Intervention / ¿Una talla única para todos? Los moderadores socioeconómicos de la salud tras el divorcio y los efectos de una intervención digital postdivorcio

Public health efforts to reduce divorce-induced health adversities are gaining momentum and positive interventional outcomes of the online Cooperation After Divorce (CAD) digital platform for divorcees have been documented by previous research. However, it is unknown whether socioeconomic characteristics previously associated with prolonged divorce recovery are also associated with post-divorce intervention efficacy, and if so, in what way. Multilevel modeling was employed using a sample of 1,856 recently divorced Danes, who participated in an RCT study of the CAD digital platform, to investigate whether educational and income level (1) predict post-divorce health, (2) moderate the time-induced trajectories of post-divorce health, and (3) moderate the intervention-induced trajectories on post-divorce health over the first 12-months following legal divorce. The findings indicated that lower education and lower income predicted worse post-divorce health over one year post-divorce. Furthermore, it was indicated that education moderated post-divorce anxiety so that lower-educated participants experienced a larger reduction in symptoms of anxiety over time. However, except for depression, no moderating effect of income and education on the intervention effect of CAD was found. Our results suggest a beneficial effect of the CAD digital platform across socioeconomic characteristics in the post-divorce period, bolstering claims of the scalability of post-divorce interventions. Moreover, the findings suggest that, theoretically, the intervention may work to compensate for the lack of educational resources in reducing the health gap in post-divorce recovery. (AU)

Las campañas de salud pública para disminuir las consecuencias negativas del divorcio para la salud están tomando impulso, y los resultados positivos de la intervención de la plataforma digital para divorciados, Cooperación tras el Divorcio (CTD), han sido documentados con investigaciones previas. No obstante, es incierto que las características socioeconómicas, antes asociadas a la recuperación prolongada del divorcio, también se asocien a la eficacia de la intervención tras el divorcio, y si es así, de qué modo. Se han utilizado modelos multinivel en una muestra de 1,856 daneses divorciados recientemente, los cuales participaron en un estudio RCT de la plataforma digital CTD con el fin de investigar si el nivel educativo y de ingresos (1) predecía la salud tras el divorcio, (2) moderaba las trayectorias de salud postdivorcio inducidas por el tiempo y (3) moderaba las trayectorias inducidas por la intervención en la salud postdivorcio durante los primeros 12 meses tras el divorcio legal. Los resultados indican que un menor nivel educativo y un un menor nivel de ingresos eran predictores de peor salud a lo largo de un año después del divorcio. Además se indicaba que el nivel educativo moderaba la ansiedad postdivorcio, de modo que los participantes de menor formación experimentaban una mayor reducción de los síntomas de ansiedad con el tiempo. No obstante, excepto para la depresión, no se encontró efecto moderador alguno de los ingresos y el nivel educativo en los efectos de la intervención de CTD. Los resultados indican que hay un efecto positivo de la plataforma digital CTD independientemente de las características socioeconómicas en el periodo postdivorcio, apoyando la escalabilidad de las intervenciones postdivorcio. Además, los resultados indican que teóricamente la intervención puede servir para compensar a las personas con un menor nivel educativo en la reducción de la brecha en salud que se produce en la recuperación postdivorcio. (AU)

Friend or foe? Postdivorce hostility among recently divorced individuals.

High levels of hostility often occur during and postdivorce and may significantly affect the quality of life, parent-child relationships, and social functioning of divorcees. Moreover, hostility may predict aggressive and violent behavior. This study sought to (a) compare average general hostility levels of a large sample of Danish divorcees to the norms of the general adult Danish population, (b) compare general hostility levels between male and female divorcees, and (c) investigate the explanatory value of various sociodemographic and divorce-related factors on postdivorce general hostility and whether these factors differ across gender. Cross-sectional baseline data (N = 1,856) from a larger randomized controlled trial study was used in this study. Normative data from a general sample of Danish adults (N = 2,040) was used for comparisons of hostility levels between our study sample and the Danish background population. This study found that male and female divorcees did not report significantly different hostility levels. However, participants reported significantly higher hostility levels postdivorce than the comparative Danish norm sample. Significant predictors of postdivorce hostility were lower age, lower educational level, infidelity as a reason for divorce, higher degree of postdivorce conflict, worse communication with the former spouse, the former spouse as the initiator of the divorce, and new partner status with neither divorcees having a new partner, or only the former spouse having a new partner. The predictive strength of the factors did not differ across gender. The findings may be especially relevant for interventions targeting problematic outcomes postdivorce (e.g., preventing aggressive behavior).

Cooperation after divorce: an RCT study of the effects of a digital intervention platform on self-perceived stress / La cooperación después del divorcio: un estudio RCT sobre los efectos en el estrés percibido de una intervención basada en una plataforma digital

Divorce has long been considered one of the most pervading stressful life events and has consistently been associated with high stress levels and subsequent poorer mental- and physical health. This study evaluates the effectiveness of the Cooperation after Divorce (CAD) online intervention on perceived stress immediately following divorce. The study's design was a one-year longitudinal randomized controlled trial including an intervention group (n = 1,031) and a no-treatment control group (n = 825) with four assessments of perceived stress levels (at baseline and 3, 6 and 12-months post-divorce). The CAD intervention consists of a 17-module online platform designed to support divorcees and their children post-divorce. Data analyses consisted of linear mixed effect modeling and means comparisons. The study found that the intervention significantly accelerated the reduction of perceived stress among recently divorced adults when compared with controls. Further, after one year, stress levels in the intervention group were reduced to normed national stress levels while the mean stress level in the control group remained substantially higher. The results suggest that online interventions may offer long-term public health benefits in reducing stress among newly divorced individuals and speak to potential implications related to the services provided for people undergoing divorce

El divorcio se ha considerado como uno de los eventos estresantes de la vida más persistentes y se ha asociado repetidamente con altos niveles de estrés y el deterioro de la salud mental y física. Este estudio evalúa la eficacia de la intervención online Cooperación Después del Divorcio (CAD) en el estrés percibido inmediatamente después de su ocurrencia. El diseño del estudio fue un ensayo controlado aleatorio longitudinal de un año que incluyó un grupo de intervención (n = 1,031) y otro de control sin tratamiento (n = 825) con cuatro evaluaciones del nivel de estrés percibido (línea base y 3, 6 y 12 meses después del divorcio). La intervención CAD consiste en una plataforma online de 17 módulos diseñada para apoyar a los divorciados y sus hijos después del divorcio. Los análisis de datos consistieron en modelos lineales de efectos mixtos y comparación de medias. El estudio encontró que la intervención aceleró significativamente la reducción del estrés percibido entre los adultos recientemente divorciados en comparación con el grupo control. Además, después de un año, el nivel de estrés en el grupo de intervención se redujo al nivel de estrés nacional normativo, mientras que el nivel de estrés promedio en el grupo control permaneció sustancialmente más alto. Los resultados sugieren que las intervenciones online pueden ofrecer ventajas para la salud pública a largo plazo para reducir el estrés entre las personas recién divorciadas y pueden tener implicaciones para los servicios que se prestan a las personas que se encuentran en un proceso de divorcio

Application of Sex Aids in Men With Sexual Dysfunction: A Review.

BACKGROUND: Although sex aids have been used in clinical practice for ages, the scientific literature assessing their application in men with sexual dysfunction is limited. AIM: To summarize medical literature regarding scientific uses of the most common sex aids in men with sexual dysfunction and assess their clinical applicability. METHODS: An extensive literature review was performed with regard to the use of sex aids in sexual medicine. Our search included journal articles, books, and guidelines in different databases: Embase, PubMed, and Cochrane. The key words were "sex aids," "sex toys," "pornography," "lubricants," "constriction bands," "dildos," "vibrators," "vacuum devices," "external penile devices," and "sex swings" were searched. Date of last search was December 4, 2018. MAIN OUTCOME MEASURES: We assessed the utility of sex aids in men with sexual dysfunction and formulated recommendations for clinicians. RESULTS: Various sex aids are available for men with sexual dysfunction. We present a comprehensive review of the most common sex aids currently available: pornography, lubricants, constriction bands, dildos, vibrators, vacuum devices, external erectile support devices, and aids to positioning. We discuss their indications, outcomes, precautions, and complications. CLINICAL IMPLICATIONS: This review is intended to provide sexual medicine practitioners and academics an overview of sex aids for men with sexual dysfunction for use in both clinical practice and research. STRENGTHS & LIMITATIONS: This is a compilation of scientific data for a topic that has broad application in sexual medicine and yet has been poorly addressed in the scientific literature. Because of the lack of sufficient data and the heterogeneous nature of different sex aids, a systematic review could not be performed. CONCLUSION: Having a comprehensive understanding of the sexual dynamics of individuals and couples combined with the appropriate integration of sex aids may have a positive effect in the treatment of male sexual dysfunctions. Miranda EP, Taniguchi H, Cao DL, et al. Application of Sex Aids in Men With Sexual Dysfunction: A Review. J Sex Med 2019;16:767-780.