Communicating with new sex partners: college women and questions that make a difference.

Despite efforts of sexuality educators, many college women are uninfluenced by information about risks of contracting a sexually transmitted disease or initiating an unintentional pregnancy. This study used an anonymous questionnaire administered to 438 never-married undergraduate women to investigate the failure of college women to ask new sex partners about sexual histories prior to sexual intercourse. Significant differences were found between the three subsample groups: those who "almost always" (AA), "sometimes" (S), or "rarely" (R) asked their sex partners about sexual histories. At first sexual intercourse, AA group women were significantly more likely to have been in a committed relationship, to have been contracepted, and to have been older; and they were less likely to have been under the influence of alcohol or other mind-altering substances. Furthermore, AA group women also reported fewer sex partners than other respondents. They also were more likely to discuss sexually related topics with their partners, to reach sexual decisions by their own thoughts, and to set personal goals.

Guilt about first intercourse: an antecedent of sexual dissatisfaction among college women.

First sexual intercourse is often viewed as a rite of passage to adulthood. While one's initial coital experience may lead to affirmation of self-identity, it is disappointing for many, resulting in feelings of guilt and shame. If guilt feelings do emerge, the likelihood of future sexual dissatisfaction is greatly increased. In particular, women with high levels of sexual guilt tend to perceive less sexual arousal, resulting in less enjoyment from their sexual encounters. The purposes of this investigation were to identify those factors correlated with feeling guilty about first sexual intercourse and to examine the influence of guilt about first intercourse on current sexual satisfaction. An anonymous questionnaire was administered to never-married college women, with the subsample for this investigation consisting of 570 women. Significant variables correlated with guilt at first sexual intercourse include uncommunicative mother and father figures, overstrict father figure, uncomfortableness with sexuality, physiological and psychological sexual dissatisfaction with first intercourse, guilt feelings about current intercourse, and psychological sexual dissatisfaction. These findings have substantial implications for sex researchers, sex therapists, family therapists, and sexuality educators who wish to promote healthy sexuality, through both attitudes and behavior.

Perceptions of pregnant/parenting teens: reframing issues for an integrated approach to pregnancy problems.

Indisputably, unplanned teen pregnancies have myriad personal, family, and social consequences, but answers to questions surrounding this phenomenon are far less obvious. The purpose of this investigation was to determine correlations, if any, between personal, family, and educational background factors and unplanned teen pregnancy. An anonymous questionnaire was administered to 341 volunteer respondents in 14 Teenage Pregnancy/Parenting Programs (TAPPS). Significant differences among respondents were related to family relationships, race/ethnicity, and sexuality education. These findings provide valuable information for family science researchers, family life educators, health personnel, policymakers, and parents who wish to ameliorate the problems in teen pregnancy/parenting by reframing issues for a more intergrated approach involving both prevention and intervention.

Masturbation and premarital sexual intercourse among college women: making choices for sexual fulfillment.

Given the potential value of masturbation as an alternative to high-risk sexual practices, there is a need to investigate factors surrounding this method of physiological sexual fulfillment. Therefore, this study examined the differences, if any, between women who have engaged in masturbation only (MO), both masturbation and sexual intercourse (MSI), and sexual intercourse only (SIO). An anonymous questionnaire was administered to volunteer respondents enrolled at a Midwestern university, yielding a subsample of 777 never-married, heterosexual women. Group comparisons indicated that MO Group women were most likely to feel guilty about engaging in masturbation and petting, but least likely to report either comfort with their sexuality or sexual satisfaction. MSI Group women indicated that, while growing up, they were less attached to their mother and father figures, whom they rated as uncommunicative. They also were more likely to have engaged in risk-related sexual behaviors. SIO Group women were more likely to have used contraceptives at first sexual intercourse and to report fewer lifetime sex partners than MSI Group women. Since a substantial number of college women refrain from engaging in masturbation, yet choose to have unprotected sexual intercourse and multiple sex partners, and others engage in masturbation but report experiencing guilt feelings regarding self-stimulation, it is of crucial importance that the negative connotations of masturbation and its attendant impact on sexual satisfaction be addressed by sexuality educators, clinicians, and researchers.

Sensitivity and reproducibility of the instantaneous hyperemic flow versus pressure slope index compared to coronary flow reserve for the assessment of stenosis severity.

The objective of this study was to compare the reproducibility and sensitivity of the instantaneous hyperemic flow versus pressure slope index (i-HFVP) and coronary flow reserve (CFR). The i-HFVP is the slope of the relationship between diastolic hyperemic coronary flow and diastolic aortic pressure, normalized for bed weight. In contrast to CFR (the ratio of hyperemic to basal coronary flow), the i-HFVP has been shown to be independent of changes in aortic pressure, heart rate, contractility, and preload. To compare reproducibility, i-HFVP and CFR were measured three times in eight dogs instrumented with high-fidelity micromanometers and flow probes, allowing for full hemodynamic recovery between phases (15 to 40 minutes). Maximum hyperemia was induced with intravenous adenosine. The sensitivity of i-HFVP and CFR was assessed in 16 instrumented dogs. Measurements were performed for one basal state and for five subcritical incremental stenoses created with a screw occluder during hyperemia. Intraclass variability correlation coefficients were 0.96 for i-HFVP but only 0.56 for CFR. Both i-HFVP and CFR showed significant decrements with each increasing stenosis. However, the percentage reductions at each level were significantly greater for the i-HFVP. The difference in percentage reduction favoring increased sensitivity of the i-HFVP ranged from 11% to 23%. It was concluded that the i-HFVP is more reproducible and more sensitive to the presence of stenoses than CFR.

Tachycardia, contractility and volume loading alter conventional indexes of coronary flow reserve, but not the instantaneous hyperemic flow versus pressure slope index.

OBJECTIVES AND BACKGROUND: Because measurements of flow reserve are often made in the setting of fluctuating hemodynamic variables that cause alterations in basal or hyperemic coronary blood flow, traditional flow reserve indexes may be difficult to interpret. Prior work in this laboratory has suggested that the instantaneous hyperemic flow versus pressure slope index is a more hemodynamically stable alternative to measures of flow reserve. Although this index has no hemodynamic dependence on changes in aortic pressure, the extent to which it is affected by other factors that alter myocardial work is unknown. Therefore, the purpose of this investigation was to analyze the effects of tachycardia (induced by atrial pacing at 10 beats/min above the basal heart rate), dobutamine infusion (10 micrograms/kg per min) and saline solution volume loading (500 ml) on measurements of traditional coronary flow reserve, the resistance reserve ratio and the instantaneous hyperemic flow versus pressure slope index. METHODS: Twenty-nine open chest anesthetized dogs were studied in four sequential stages: baseline, tachycardia, dobutamine infusion and saline solution volume loading. Traditional coronary flow reserve was defined as the ratio of hyperemic coronary blood flow to basal coronary blood flow, the resistance reserve ratio as the ratio of basal coronary resistance to hyperemic coronary resistance and the instantaneous hyperemic flow versus pressure slope index as the slope of the instantaneous relation between diastolic hyperemic coronary blood flow and diastolic aortic pressure normalized by perfusion bed weight. Hyperemia was induced by intravenous adenosine infusion (1 mg/kg per min). Mean aortic pressure was kept nearly constant during the interventions by manipulation of an aortic clamp or a vena caval snare. RESULTS: The final study group comprised 18 open chest dogs. Coronary flow reserve was significantly decreased by tachycardia (3.7 +/- 1.2 to 3.0 +/- 1.2, p < 0.0001), decreased by saline solution volume loading (3.2 +/- 1.3 vs. 2.7 +/- 0.8, p = 0.06) and significantly increased by dobutamine infusion (3.2 +/- 1.3 to 4.3 +/- 1.5, p < 0.0005). In contrast, the instantaneous hyperemic flow versus pressure slope index was not affected by the three interventions (7.4 +/- 3.1 vs. 7.3 +/- 3.3, 7.4 +/- 3.2 vs. 7.4 +/- 3.4 and 7.5 +/- 3.1 vs. 7.3 +/- 3.4, respectively, all p = NS). The changes observed in the resistance reserve ratio were of similar or greater magnitude and significance to the changes in coronary flow reserve. CONCLUSIONS: The instantaneous hyperemic flow versus pressure slope index offers a hemodynamically stable alternative to measures of vascular reserve because it is independent of moderate changes in heart rate, contractility and volume loading that may occur commonly in clinical situations.

Establishing comprehensive, quantitative criteria for detection of restenosis and remodeling after percutaneous transluminal coronary angioplasty.

To establish comprehensive criteria for detecting restenosis and remodeling, inter- and intraobserver reproducibility of quantitative arteriography in the analysis of 20 lesions immediately after and 6 months after percutaneous transluminal coronary angioplasty (PTCA) were assessed. Geometric single-plane (minimum, maximum, mean diameter and percent diameter stenosis), biplane (absolute and relative cross-sectional area stenosis), relative densitometric area stenosis and the average of densitometric area stenosis in orthogonal views were compared. A high intra- and interobserver reproducibility of all absolute measurements was found, with the highest correlations for minimum diameter and cross-sectional area (interobserver, r = 0.85 and 0.85; intraobserver, r = 0.93, and 0.95 for minimum diameter and cross-sectional area, respectively). Of the relative measurements, biplane geometric percent cross-sectional area stenosis was the most reliable and percent densitometric area stenosis was the most variable (interobserver, r = 0.67; intraobserver, r = 0.71). Only small differences were demonstrated for the absolute measurements between the analysis of lesions immediately after PTCA and after follow-up, whereas a greater variability was found for relative measurements, especially videodensitometry. In both circumstances, a poor correlation between relative densitometric cross-sectional area from orthogonal views was found, whereas geometric elliptical cross-sectional area correlated quite well with the average of densitometric percent cross-sectional area in orthogonal views (interobserver, r = 0.86; intraobserver, r = 0.84). Thus, data in this study support the suitability of geometric quantitative analysis for the assessment of PTCA results. Densitometry was the least reliable quantitative parameter.

Instantaneous hyperemic flow-versus-pressure slope index. Microsphere validation of an alternative to measures of coronary reserve.

BACKGROUND: The instantaneous hyperemic flow-versus-pressure (i-HFVP) slope index is a new method of assessing maximal coronary conductance and can be used as an alternative to conventional measures of coronary reserve. The i-HFVP slope index is determined by measuring the slope of the linear diastolic segment of the relation between instantaneous aortic pressure and hyperemic coronary flow. METHODS AND RESULTS: To validate the i-HFVP slope index as a measure of maximal coronary conductance, we compared this method with a microsphere-derived measurement of maximal coronary conductance (m-HFVP slope index) by determining the slope of the least-squares regression line of the data points for coronary flow during maximal hyperemia and four or five steady-state alterations of aortic pressure in 43 dogs (open-chest, anesthetized preparations) with or without coronary stenoses. The i-HFVP slope index demonstrated no dependence on heart rate, left ventricular end-diastolic pressure, or mean aortic pressure and was highly reproducible within the groups studied (intraclass correlation coefficient, 0.86 for normal arteries, 0.87 for stenotic arteries, and 0.93 for combined groups; for all coefficients, p less than 0.001). The i-HFVP slope index was significantly decreased in the presence of a stenosis (10.3 +/- 3.9 for normal arteries versus 3.6 +/- 1.6 for stenotic arteries, p less than 0.001) as was the transmural m-HFVP slope index (8.9 +/- 4.6 for normal arteries versus 5.3 +/- 3.1, p less than 0.01). Of special importance, the i-HFVP slope index measurement for normal arteries was not significantly different from the transmural and subendocardial m-HFVP slope index measurements (10.3 +/- 3.9 versus 8.9 +/- 4.6 and 9.2 +/- 5.7, respectively). For stenotic arteries, the i-HFVP slope index measurement was also not significantly different from the transmural and subendocardial m-HFVP slope index measurements (3.6 +/- 1.6 versus 5.3 +/- 3.1 and 4.1 +/- 2.3, respectively). The i-HFVP slope index correlated best with subendocardial m-HFVP slope index measurements (correlation coefficient, 0.57; p less than 0.001). When the 95% confidence intervals for the transmural (or subendocardial) m-HFVP slope index in normal arteries were compared with the i-HFVP slope index values, the latter demonstrated a systematic trend to overestimate the m-HFVP slope index. In the presence of a stenosis, this effect was minimized, and the slope values were nearly identical. CONCLUSIONS: The i-HFVP slope index correlates most closely with subendocardial coronary conductance; the index is a hemodynamically independent measure of coronary reserve that is reproducible over a broad range of aortic pressures; and the methodology is applicable to an intact circulation in experimental preparations and may with future developments also prove useful in humans.

Energy cost of ambulation in paraplegic patients using Craig-Scott braces.

Energy metabolism data were collected in a series of 8 male paraplegic patients with neurologically complete spinal cord lesions between T4 and T12 (1 patient had complete motor paralysis with incomplete sensory function). Energy costs were measured at the subject's seated basal rate (mean = 17.12cal/min/kg) and during 2 separate trials at ambulation using Craig-Scott braces. The rates of ambulation reflected the patient's perceived comfortable rate and ranged from 2.2 to 44.8m/min. (mean = 14m/min). The subjects ambulated in a straight line, with the data collection instrumentation (the Mobile Automatic Metabolic Analyzer) moving alongside. Mean O2 consumption was 0.1867ml/sec/kg and mean energy cost was 52.96 cal/min/kg, which when compared to a mean of 17.12 cal/min/kg at their resting state, represents a 3-fold increase in their energy cost. Three cases were further measured for O2 debt, which ranged from 1483 to 3112 ml and was repaid completely within 10 minutes post-walk.

Amputation: energy cost of ambulation.

A mobile instrument system was used to measure energy consumption by indirect calorimetry at rest and during ambulation in 25 unimpaired subjects, 6 unilateral below-knee (BK) amputee patients, 6 unilateral above-knee (AK) amputee patients and 4 bilateral AK amputee patients. To prevent the introduction of gait difficulties among the impaired subjects, each subject was permitted to walk at his own comfortable speed. Since speed thus varied among subjects, ambulation data were expressed in units of energy per foot traveled. Statistical analyses of the mean oxygen costs indicated several significant differences among the groups. In comparison to unimpaired subjects, the mean oxygen consumption was 9% higher in unilateral BK amputee patients, 49% higher in unilateral AK amputee patients and 280% higher in bilateral AK amputee patients.