Body mass index, sexual difficulties and sexual satisfaction among people in regular heterosexual relationships: a population-based study.

BACKGROUND/AIMS: The aims of this study were to clarify the relationship between body mass index (BMI) and sexual difficulties and to investigate if BMI influenced sexual satisfaction, over and above the effects of sexual difficulties. METHODS: Cross-sectional analyses of a nationally representative computer-assisted telephone interview. Eight thousand, six hundred and fifty-six respondents were recruited by random digit dialling in 2004-2005. Only those in a sexually active, heterosexual relationship were included in the current analyses. RESULTS: After adjustments for demographic factors, both overweight and obese male and female participants were more likely to report worrying during sex about whether their body was unattractive. Among women, associations were also found between higher BMI and lack of interest in sex. No other significant associations between BMI and sexual difficulties were evident. There was an association between BMI and extreme physical pleasure for women but not men over and above the effects of sexual difficulties, with obese women being more likely than normal weight women to report extreme physical pleasure. No associations were found for either men or women between BMI and whether or not they reported extreme emotional or sexual satisfaction with their relationship. CONCLUSIONS: With the exception of body image difficulties, there is little association between BMI and self-reported sexual difficulties. Furthermore, extreme sexual and emotional satisfaction appeared to be associated with the presence or absence of sexual difficulties and not overly influenced by BMI. Overall, clinicians and patients should be aware that being overweight is not necessarily detrimental to sexual functioning.

Knowledge of sexually transmissible infections: a comparison of prisoners and the general population.

The World Health Organization (WHO) has identified a failure to provide education for vulnerable populations such as prisoners as a contributing factor to the epidemic of sexually transmissible infections (STIs). Despite this recognition, little is known about prisoners' level of knowledge of STIs compared with the general population. Using computer-assisted telephone interviews, we compared a representative sample of 2289 Australian prisoners, aged 18-59 years from New South Wales and Queensland prisons with a representative community sample of 3536 participants from these two states. Prisoners had significantly better knowledge than the general community of chlamydia-related questions, while knowledge of herpes (genital and oral) was slightly better in the community sample. Prisoners who were aged over 25 years, not married, female, self-identified as either homosexual or bisexual and reported a history of STIs tended to have better STI knowledge levels. Despite their more disadvantaged backgrounds, prisoners demonstrated relatively good health literacy in relation to STIs. Ongoing education about the transmission risks of STIs for prisoners and the general community is needed.

Healthcare-seeking strategies among displaced children in war-ridden northern Uganda: the case of malaria.

A field study was performed to examine suffering and treatment seeking from the perspective of children aged 8-16 years living in war-affected northern Uganda. Various techniques for collecting qualitative and quantitative data were used, including a semi-structured questionnaire about illness experiences and medicine use over a 1-month recall period. The 165 children who were interviewed were attending primary schools for displaced children and/or commuters' night shelters. The children frequently attributed their common febrile ailments to malaria and used a variety of pharmaceuticals and herbal remedies, as self-medication, for their self-diagnosed malarial episodes. Misdiagnosis of febrile illnesses by the children (as well as by the local healthcare providers) and frequent misuse of medicines in the treatment of these illnesses appeared to be very common. Improvement of the health conditions of these children requires a change of focus. Firstly, children above the age of 5 years who are not under adult care and who are often no longer welcome in the local hospital's paediatric ward need to be accepted at the outpatient clinics currently intended for adults. Secondly, the local diagnostic system needs to be improved, not only so that malaria can be reliably diagnosed but also so that alternative diagnoses can be confirmed or rejected, otherwise the current over-consumption of antimalarial drugs may simply be replaced with an over-consumption of antibiotics.

Stable enhancement of near-band-edge emission of ZnO nanowires by hydrogen incorporation.

We report on the photoluminescence properties of ZnO nanowires treated with a mild Ar plasma. The nanowires exhibited stable and strong enhancement of the near-band-edge emission and quenching of the deep level emission. The low temperature PL revealed a strong hydrogen donor-bound-exciton line in the plasma-treated samples indicating unintentional incorporation of hydrogen during the plasma treatment. To confirm the results, hydrogen was implanted into the ZnO nanowires with a low ion energy of 600 eV and different fluences. The observed result can be related to the passivation of deep centers by hydrogen. The absolute photoluminescence intensity measured by an integrating sphere showed stable and strong UV emission from the treated samples even after several weeks.

Are sexual problems more common in women who have had a tubal ligation? A population-based study of Australian women.

OBJECTIVE: To investigate whether women who have had a tubal ligation are more likely to experience sexual problems than other women. DESIGN: Population-based telephone survey. SETTING: Australia-wide, including cities, regional towns, and rural areas. POPULATION: A total of 3448 Australian women aged between 16 and 64 years. METHODS: Women were surveyed using random-digit dialling throughout 2004 and 2005. MAIN OUTCOME MEASURES: Prevalence of sexual problems and ratings of sexual satisfaction, relationship satisfaction, and sexual pleasure. RESULTS: From a weighted sample of 2721 women, 447 (16.4%) reported having had a tubal ligation, with 85.0% currently aged between 40 and 64 years. Having a tubal ligation was not associated with any specific sexual problem, such as physical pain during sex or an inability to reach orgasm. In fact, after controlling for age and other sociodemographic differences, sterilised women were significantly less likely than non-sterilised women to lack an interest in having sex (OR 0.69, 95% CI 0.54-0.89), to take 'too long' to reach orgasm (OR 0.69, 95% CI 0.50-0.96), to experience vaginal dryness during sex (OR 0.70, 95% CI 0.50-0.96), and to find sex unpleasurable (OR 0.64, 95% CI 0.46-0.90). Sterilised women were also more likely to experience extremely high levels of sexual satisfaction (OR 1.66, 95% CI 1.27-2.18), relationship satisfaction (OR 1.29, 95% CI 1.01-1.67), and sexual pleasure (OR 1.59, 95% CI 1.20-2.12). CONCLUSIONS: Our findings suggest no adverse effects, and possibly some benefits, for the sexual lives of women undergoing tubal ligation. These findings should be included with other educational material for couples considering sterilisation as a contraception option.

Uterine rupture in The Netherlands: a nationwide population-based cohort study.

OBJECTIVE: To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. DESIGN: Population-based cohort study. SETTING: All 98 maternity units in The Netherlands. POPULATION: All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021). METHODS: Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in The Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar. MAIN OUTCOME MEASURES: Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. RESULTS: There were 210 cases of uterine rupture (5.9 per 10,000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10,000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). CONCLUSION: The population-based incidence of uterine rupture in The Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.

Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371,000 pregnancies.

OBJECTIVE: To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. DESIGN: Prospective population-based cohort study. SETTING: All 98 maternity units in the Netherlands. POPULATION: All pregnant women in the Netherlands. METHODS: Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371,021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. MAIN OUTCOME MEASURES: Incidence, case fatality rates, possible risk factors and substandard care. RESULTS: Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10,000), eclampsia in 222 women (incidence 6.2/10,000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. CONCLUSIONS: Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge.

Enhanced surface-excitonic emission in ZnO/Al(2)O(3) core-shell nanowires.

We report the influence of an Al(2)O(3) shell on the photoluminescence emission of ZnO nanowires. At room temperature, the spectrum of the core-shell nanowires shows a strong reduction of the relative intensity of the green defect emission with respect to the near-band-edge emission. At 5 K an increase of the relative intensity of the surface exciton band with respect to the donor-bound exciton emission is observed. Annealing the core-shell nanowires at 500 °C does not increase the green defect luminescence at 5 K. We propose a model explaining the spectral changes.

Smoking and erectile dysfunction: findings from a representative sample of Australian men.

OBJECTIVES: To examine whether there is an association between smoking and erectile dysfunction in a representative sample of Australian men. DESIGN: Secondary analysis of cross-sectional survey data from the Australian Study of Health and Relationships. PARTICIPANTS: 8367 Australian men aged 16-59 years. MAIN OUTCOME MEASURES: Erectile dysfunction was identified in men who reported having had trouble keeping an erection when they wanted to, a problem which persisted for at least one month over the previous year. Variables examined in multivariate logistic regression analyses included age, education, presence of cardiovascular disease and diabetes, and current alcohol and tobacco consumption. RESULTS: Almost one in 10 of the respondents (9.1%) reported erectile dysfunction that lasted for at least one month over the previous year. More than a quarter (27.2%) of respondents were current smokers, with 20.9% smoking < or = 20 cigarettes per day, and 6.3% smoking > 20 cigarettes per day. Compared with non-smokers, the adjusted odds ratios for erectile dysfunction were 1.24 (95% confidence interval (CI) 1.01 to 1.52, p = 0.04) for those smoking < or = 20 cigarettes per day and 1.39 (95% CI 1.05 to 1.83, p = 0.02) for those smoking > 20 cigarettes per day, after adjusting for other confounding factors. Older age, low level of education, and taking medications for cardiovascular disease were also independently and positively associated with erectile dysfunction. In contrast, moderate alcohol consumption (1-4 drinks per day) significantly reduced the likelihood of having erectile dysfunction. CONCLUSIONS: Erectile dysfunction is a significant health concern affecting around one in 10 Australian men aged 16-59 years. Current smoking is significantly associated with erectile dysfunction in Australian males. This association was strengthened as the number of cigarettes smoked increased. Health promotion programmes could use the link between smoking and erectile dysfunction to help reduce smoking levels among men.

Seroconversion in context.

This paper describes the accounts that homosexually active men give of their HIV seroconversion and interrogates these accounts for risk discourses. In particular, this paper asks whether the risk discourses of HIV researchers and educators are present in the men's narratives of their own seroconversion. Such discourses make reference to 'unsafe' sex--particularly the practice of unprotected anal intercourse, numbers of sexual partners or 'promiscuity', and the disinhibiting effect of drugs and alcohol. The data are drawn from an ongoing case-series study of seroconversion in which men who had seroconverted were asked to give an account of the occasion on which they believe they were infected. A number of themes were identified in the men's accounts. The men's descriptions of what they believe to be the seroconversion event indicate that their attributions, i.e., the reasons they give for their HIV infection, vary depending on the context. Within regular relationships, breakdown of negotiated safety, love and intimacy, and fatalism were among the explanations given. Seroconversion attributed to casual sexual encounters was more likely to be explained in terms of pleasure, lack of control, and with reference to particular sexual settings. The ways in which men understood their HIV infection were informed both by the risk discourse of HIV researchers and also by the discourses of love and pleasure, as well as that of control.

Women in contact with Sydney's gay and lesbian community: sexual identity, practice and HIV risks.

Total rates are low, but sex with a man remains the main risk for HIV transmission to women in Australia. In February 1998, 774 women in contact with gay, bisexual and lesbian communities completed a two-page questionnaire. Almost all respondents had some social contact with gay men. Two-thirds (503) thought of themselves as lesbian/dyke/homosexual/gay, 13% (100) as bisexual and 17% (133) as heterosexual/straight. In total, 212 women (27%) said they had ever had sex with a gay or bisexual man; 51 women (7%) had done so in the past six months. About 2% of the lesbians said they had recently had sex with a gay/bi man, as had 8% of the heterosexuals and 25% of the bisexuals; 25 women had recently had unprotected vaginal or anal intercourse with a male gay/bi partner. Forty-eight women (6%) had done sex work. Asked about drug use, 61 women (8%) said they had injected in the past six months. Twenty-three women had shared injecting equipment with someone, and five had shared with a gay/bi man. Compared with other women, these women have high rates of injecting drug use. If they have sex with men, these men are more likely to be gay or bisexual than are the male sexual partners of women moving in largely heterosexual milieux. For a case of so-called 'heterosexual' transmission of HIV to occur, neither person need be heterosexual.

Age at first intercourse in an Australian national sample of technical college students.

OBJECTIVE: This study aims to broaden the current body of knowledge regarding the sexual behaviour of young Australians by examining the age and correlates of age of first intercourse in a national sample of Technical and Further Education apprentices. METHOD: In 1995, students at randomly selected technical colleges in Australia were surveyed on HIV-related issues. Questionnaires were administered to a stratified cluster sample of automotive, hairdressing and commercial cookery apprentices. Respondents were asked the age at which they first had heterosexual vaginal or anal intercourse. RESULTS: Of 4,055 respondents aged 15-24 years, 3,848 answered the question; 3,195 (83%) had had intercourse. Males and females did not differ significantly. Median age at first intercourse was 16 (range 12-23). In multivariate analysis, older age at first intercourse was associated with: greater age at interview; higher school education; church attendance; and State of residence. The model, however, accounted for only 14% of the variance in age at first intercourse. CONCLUSIONS AND IMPLICATIONS: In this sample, those apprentices who completed secondary school became sexually active later on average than those who left before the end of Year 10. For sex education to occur before sexual initiation, it needs to be offered in primary schools and the first year of high school (aged 11-13 years). Further, as technical college students are likely to initiate sex earlier than their age mates still at school, colleges may be in a position to take responsibility for the continuing sexual education of this group, especially for those students entering college at 15 or 16 years of age.

Condom use and 'withdrawal': exploring gay men's practice of anal intercourse.

Some gay men who have unprotected anal intercourse avoid ejaculation-they practise 'withdrawal'. Using data collected in 1997 from a sample of Sydney gay men (n=625), we explored the relation between men's practice of ejaculation and their use of condoms. We also investigated whether men who had unprotected withdrawal but not unprotected ejaculation were more likely to think unprotected withdrawal was safe, liked condoms less, liked anal intercourse more, or were more sexually adventurous. Considering separately insertive and receptive anal intercourse with regular and with casual partners, we found that the majority of men who practised unprotected withdrawal also practised unprotected ejaculation. Of those whose only unprotected sex was withdrawal ('true withdrawers'), most never used condoms (they did not also have protected sex with ejaculation). True withdrawers were compared with men who had unprotected ejaculation, who always used condoms, who had no anal sex and who had no partners. Those who were true withdrawers with casual partners were more likely to believe withdrawal was safe; no group effects were found with regular partners. No significant differences in condom attitudes were found. True withdrawers with regular partners liked anal intercourse less than other men, but true withdrawers with casual partners were indistinguishable from those who had unprotected ejaculation. True withdrawers did not differ in sexual adventurousness from other men who had anal intercourse. Most withdrawers avoided anal sex with ejaculation rather than use condoms. Converting them into reliable condom users may be a considerable challenge for health promotion.

The abduction of disorder in psychiatry.

The evolutionary cornerstone of J. C. Wakefield's (1999) harmful dysfunction thesis is a faulty assumption of comparability between mental and biological processes that overlooks the unique plasticity and openness of the brain's functioning design. This omission leads Wakefield to an idealized concept of natural mental functions, illusory interpretations of mental disorders as harmful dysfunctions, and exaggerated claims for the validity of his explanatory and stipulative proposals. The authors argue that there are numerous ways in which evolutionarily intact mental and psychological processes, combined with striking discontinuities within and between evolutionary and contemporary social/cultural environments, may cause nondysfunction variants of many widely accepted major mental disorders. These examples undermine many of Wakefield's arguments for adopting a harmful dysfunction concept of mental disorder.

Who's up first? Testing for order effects in structured interviews using a counterbalanced experimental design.

A growing body of research suggests that, apart from the wording of specific questions, various aspects of the interview process itself may affect the reliability of information provided by research participants. To examine whether the order of presentation of specific diagnostic modules affects the likelihood of subjects' yes/no responses within the Diagnostic Interview Schedule for Children (DISC), the authors used a counterbalanced design, presenting two DISC diagnostic modules to children and their parents in standard or reversed order. Results indicate that the order of module administration exerts effects on the total numbers of symptoms endorsed, level of impairment, and the likelihood of meeting diagnostic criteria, regardless of whether the information is provided by parent or child respondents. Future child and adult assessment measures should take these difficulties fully into account through novel approaches to instrument design and interview procedures.

National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices.

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first child multisite cooperative agreement treatment study of children conducted by the National Institute of Mental Health, Rockville, Md. It examines the long-term effectiveness of medication vs behavioral treatment vs both for treatment of ADHD and compares state-of-the-art treatment with routine community care. In a parallel-groups design, 576 children (age, 7-9 years) with ADHD (96 at each site) are thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, (4) or community comparison. The first 3 groups are treated for 14 months and all are reassessed periodically for 24 months. Designers met the following challenges: framing clinically relevant primary questions; defining the target population; choice, intensity, and integration and combination of treatments for fair comparisons; combining scientific controls and standardization with clinical flexibility; and implementing a controlled clinical trial in a nonclinical setting (school) controlled by others. Innovative solutions included extensive decision algorithms and manualized adaptations of treatments to specific needs.