Sexual Rehabilitation and Relational Satisfaction in People with Multiple Sclerosis and their Partners.

Sexuality is an integral part of our existence. Multiple Sclerosis (MS) can complicate the lifelong course of sexual development and the ways in which one defines and expresses sexuality. Unfortunately, these issues are not adequately addressed by the health professionals involved in the rehabilitation process. Present research attempts to study the effect that can arise on the sexual and relational satisfaction of couples having a partner with MS after the implementation of a sexual rehabilitation program. 60 couples where one partner has MS and the other does not, were divided into three groups and accepted the PLISSIT (PLISSIT stands for Permission, Limited Information, Specific Suggestions, Intensive Therapy) sexual rehabilitation program as follows: Group a (n = 40, control group) completed self-referencing questionnaires at three times (initial measurement, after 10 weeks and 6 months later), group b (n = 40) did 10 weeks of sexual counselling and completed the same questionnaires at the same times and group c (n = 40) followed the PLISSIT programme and was evaluated in the same way at the same times. The implementation of PLISSIT improved Sexual Dysfunction (SD) levels, increased sexual satisfaction between partners along with general relational satisfaction. PLISSIT can be used by professionals involved in the management of the disease as a comprehensive psychosexual rehabilitation program for MS patients and their partners.

Heterosexual relationship characteristics, condom use and safe sex practices.

It was examined whether sexual relationship characteristics were associated with condom use and safe sex practices against HIV. Characteristics investigated were: (1) age difference between sexual partners, (2) previous knowledge of partner, (3) type of relationship, (4) duration, and (5) exclusiveness. Safe sex practices (risky, non-safe, safe) were defined by condom use consistency, previous knowledge of partner and monogamy. Participants (N = 458, were Greek, sexually active and between 18-25 years old) responded to a questionnaire on sexual and condom use practices in their sexual relationships of the past 12 months, condom use negotiation and variables a-e. Only age difference between partners was found to differentiate consistent from inconsistent condom use. Inconsistent condom use was more frequent among partners whose age difference was over two years. Safe sex practices (risky, non-safe, safe) varied across different relationships of 36% and remained consistently non-safe or risky across those of 40%. Risky practices occurred more frequently in relationships where the man was older than the woman. When condoms had not been used, they had not been negotiated in 80% of the cases. These findings reconfirm the importance of negotiation in condom use, call attention to the neglected role of age differences between partners in safe sex and bring forward the issue of studying actual variation of safe sex practices across relationships as an indication of people's response to health campaign messages of risk reduction.

The Leros PIKPA asylum. Deinstitutionalisation and rehabilitation project.

A three-year deinstitutionalisation and rehabilitation pilot intervention project was implemented at Leros PIKPA for people with severe learning disabilities. Initial conditions at the asylum were appalling. Residents suffered severe deprivation, extreme institutionalisation, and violation of basic human rights. Intervention involved professionals from different disciplines, and involved residents, their families, care staff, the institution, and the local community. As a result, resident care and adaptive behaviour has started to improve. Communication between residents and families has increased. Owing to training and sensitisation, care staff's poor resident-management practices and negative attitudes toward disabled people have changed. Living and hygienic conditions have been upgraded and building renovation is under way. Asylum administration and the local community have been sensitised to residents' needs. Eleven residents have moved to the project's pilot community home in Athens; two others now live with foster families. The results suggest that deinstitutionalisation and rehabilitation can be successfully initiated even in residential institutions of the severest kind.

The psychosocial dynamics of change at Leros PIKPA asylum.

The pilot intervention project at Leros PIKPA asylum was resisted at all levels of its implementation. Resistance ranged from implicit and passive to explicit and hostile. It took the form of strong rejective attitudes, defensiveness, and repressed emotions of guilt, shame and fear. It was apparent in efforts to delay, obstruct or reverse the progress of the project and undermine the work of intervention team members. It was evident in the interactions of the intervention team with all parties involved in implementing the project: medical professionals and welfare services, the state and local administrations, the central and local administrations of PIKPA staff, the local community, and the asylum residents' families and relatives. It is argued that this resistance to change is due to the interplay of cultural/attitudinal, psychodynamic and socio-economic factors that are not unique to Leros or Greece. The analysis of the psychosocial processes involved in resistance to changing the Leros PIKPA asylum may offer insights to the deinstitutionalisation of custodial settings in general.

Change in care staff's attitudes towards people with learning disabilities following intervention at the Leros PIKPA asylum.

The pilot intervention project at Leros PIKPA asylum sought to change the management of residents by decreasing care staff's tendency to view people with learning disabilities with attitudes of custodial segregation (e.g. "they should all live in institutions") and categorisation (e.g. "they are all alike"). To that end, staff were trained on the job in resident management and participated in seminars, sensitisation groups, clinical case presentations and visits to model rehabilitation units. To investigate whether staff attitudes towards people with learning disabilities had been influenced, staff members responded to a questionnaire of such attitudes, in March 1991 (initial assessment) and a year later (reassessment). Factor analyses of attitude ratings at initial assessment revealed a strong negative attitudinal construct, "Rejective and custodial segregation--Categorisation", according to which institutionalisation was the only appropriate type of care for people with learning disabilities, regardless of individual differences. At reassessment, however, this factor had split into two independent ones, "Rejective and custodial segregation" and "Categorisation", suggesting that the staff had understood that custodial care did not apply to all persons with learning disabilities indiscriminately. Reassessment factors further indicated that staff had comprehended the appropriateness of alternative care forms--community and home care. Analysis of Categorisation and Custodial segregation attitude ratings showed that only staff's tendency to view the disabled as "all alike" (Categorisation) had decreased at reassessment. The latter change and the structural change revealed by the factor analyses imply that staff's attitudes underwent a small but significant modification.

Mortality among institutionalised people with learning disabilities in Greece: a 30-year survey at the Leros PIKPA asylum.

The life expectancy of institutionalised people with learning disabilities is shorter than that of the general population. Data on population dynamics in institutions for such people are vital for planning purposes. Mortality can be considered a crude measure of quality of health care. Mortality data on the 914 admissions to the Leros PIKPA asylum for children and young adults with learning disabilities and associated problems in the years 1961-91 were reviewed. The overall crude mortality rate was 59.2 deaths per 1000 person-years. Twenty-two per cent of the deaths occurred within a year after admission. Age-specific mortality rates were particularly high for those aged one to four years, and declined thereafter. Male residents had lower mortality than female residents in almost all of the age groups. Compared with sex- and age-specific mortality data for the general population of Greece, the observed rates were 20-150 times higher but still comparable to those reported for people with more severe learning disabilities in institutions in other countries. Lifetable analysis by length of stay showed that male residents had a statistically significant higher probability of survival than female residents, which could not be attributed to age-related differential mortality. Culture-specific differential admission criteria may account for the observed sex difference.