Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women.

BACKGROUND: Several studies have demonstrated that culture plays a fundamental role in individuals' beliefs, attitudes, and values toward sexuality, and influences their ability to enjoy sex. It follows that culture may influence sexual satisfaction or dissatisfaction. AIM: To examine and compare cognitive-emotional variables related to women's sexual dissatisfaction in Iran and New Zealand. METHODS: In total, 196 Iranian women and 207 New Zealand women participated in the study, answering questionnaires evaluating dysfunctional sexual beliefs, automatic thoughts, emotional and sexual response during sexual activity, as well as sexual satisfaction. OUTCOMES: Sexual beliefs were measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotional responses were measured by the Sexual Modes Questionnaire, and sexual satisfaction was measured by the Sexual Satisfaction Index. RESULTS: Findings indicated that in both Iranian and New Zealand women, failure and disengagement thoughts, lack of erotic thoughts, and emotions of fear during sexual activity were significant predictors of sexual dissatisfaction. Besides these common predictors, results also indicated that sexual conservatism and women's sexual passivity beliefs, sexual abuse thoughts, and fear during sexual activity were significant predictors of sexual dissatisfaction in Iranian women. Beliefs of sexual desire and pleasure as a sin; age-related beliefs; and emotions such as sadness, disillusion, and hurt were significant predictors of sexual dissatisfaction in New Zealand women. CLINICAL TRANSLATION: The present findings could facilitate a better understanding of cultural differences in the roles played by dysfunctional sexual beliefs, negative automatic thoughts, and negative emotions during sexual activity, and the value of these beliefs, thoughts, and emotions in predicting sexual dissatisfaction. CONCLUSIONS: The strength of this study is in providing an examination of the role of culturally bound beliefs in predicting sexual dissatisfaction in women from different cultural backgrounds. Limitations include the lack of evaluation of psychological and interpersonal variables that may impact on women's sexual dissatisfaction. These findings suggest that there may be a role of culture in shaping beliefs, attitudes, and values toward sexuality; and provide evidence for the effect of cognitive-emotional variables in predicting women's sexual dissatisfaction. Abdolmanafi A, Nobre P, Winter S, et al. Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women. J Sex Med 2018;15:687-697.

A research and evaluation capacity building model in Western Australia.

Evaluation of public health programs, services and policies is increasingly required to demonstrate effectiveness. Funding constraints necessitate that existing programs, services and policies be evaluated and their findings disseminated. Evidence-informed practice and policy is also desirable to maximise investments in public health. Partnerships between public health researchers, service providers and policymakers can help address evaluation knowledge and skills gaps. The Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) aims to build research and evaluation capacity in the sexual health and blood-borne virus sector in Western Australia (WA). Partners' perspectives of the SiREN model after 2 years were explored. Qualitative written responses from service providers, policymakers and researchers about the SiREN model were analysed thematically. Service providers reported that participation in SiREN prompted them to consider evaluation earlier in the planning process and increased their appreciation of the value of evaluation. Policymakers noted benefits of the model in generating local evidence and highlighting local issues of importance for consideration at a national level. Researchers identified challenges communicating the services available through SiREN and the time investment needed to develop effective collaborative partnerships. Stronger engagement between public health researchers, service providers and policymakers through collaborative partnerships has the potential to improve evidence generation and evidence translation. These outcomes require long-term funding and commitment from all partners to develop and maintain partnerships. Ongoing monitoring and evaluation can ensure the partnership remains responsive to the needs of key stakeholders. The findings are applicable to many sectors.

What's wrong with John? a randomised controlled trial of Mental Health First Aid (MHFA) training with nursing students.

BACKGROUND: The prevalence of mental health problems have been found to be higher among university students compared to their non-student peers. Nursing students in particular face a range of additional stressors which may impact their undergraduate performance and their careers. Mental Health First Aid (MHFA) aims to increase mental health literacy and to reduce stigma and may positively impact on the student population. This paper describes a MHFA randomised controlled trial targeting nursing students at a large Australian university. This study aimed to measure the impact of the MHFA course on mental health literacy, mental health first aid intentions, confidence in helping someone with a mental health problem and stigmatising attitudes including social distance. METHODS: Participants were first year nursing students (n = 181) randomly allocated to the intervention (n = 92) or control (n = 89) group. Intervention group participants received the standardised MHFA course for nursing students. Online self-report questionnaires were completed at three time intervals: baseline (one week prior to the intervention: T1) (n = 140), post intervention (T2) (n = 120), and two months post intervention (T3) (n = 109). Measures included demographics, mental health knowledge, recognition of depression, confidence in helping, mental health first aid intentions and stigmatising attitudes including social distance. Repeated measures ANOVA was computed to measure if the impact of time (T1, T2, T3) and group (intervention and control) on the outcome variables. RESULTS: There was a significant improvement among intervention compared to control group participants across the three time periods for knowledge scores (p < 0.001), confidence in helping (p < 0.001), mental health first aid intentions (p < 0.001), total personal stigma (p < 0.05), personal dangerous/unpredictable stigma (p < 0.05) and social distance (p < 0.05) scores. CONCLUSION: MHFA is useful training to embed in university courses and has the potential to enhance mental health literacy and reduce stigmatising attitudes and social distance. While this course has particular salience for nursing and other health science students, there are broader benefits to the general university population that should be considered and opportunities accordingly explored for all students to complete the course. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000861651 . Retrospectively registered 11 August 2014.

Prevalence and risk factors of sexual dysfunction in postpartum Australian women.

INTRODUCTION: Female sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals. AIM: The aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth. METHODS: Postpartum women who had given birth during the previous 12 months were invited to participate in this cross-sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ-8), and the Relationship Assessment Scale. Responses from 325 women were analyzed. RESULTS: Almost two-thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three-quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction. CONCLUSION: Sexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions.

An update on sexual function and dysfunction in women.

Sexual function of women can be affected by many factors resulting in female sexual dysfunction (FSD). Sexual dysfunction is a common problem among women of all ages and has negative effects not only on their quality of lives but also on the sexual function and quality of life of their partners. It can also affect mental health of the entire family and society. Regarding the multidimensional nature of female sexual dysfunction and considering its consequences, this condition needs to be recognised in its early stages in order to prevent future consequences and impacts. This article discusses biopsychosocial aspect of female sexual function, classifications and risk factors of female sexual dysfunction and investigates current approaches to identify and treat this problem.

Mental health first aid training for nursing students: a protocol for a pragmatic randomised controlled trial in a large university.

BACKGROUND: The impact of mental health problems and disorders in Australia is significant. Mental health problems often start early and disproportionately affect young people. Poor adolescent mental health can predict educational achievement at school and educational and occupational attainment in adulthood. Many young people attend higher education and have been found to experience a range of mental health issues. The university setting therefore presents a unique opportunity to trial interventions to reduce the burden of mental health problems. Mental Health First Aid (MHFA) aims to train participants to recognise symptoms of mental health problems and assist an individual who may be experiencing a mental health crisis. Training nursing students in MHFA may increase mental health literacy and decrease stigma in the student population. This paper presents a protocol for a trial to examine the efficacy of the MHFA training for students studying nursing at a large university in Perth, Western Australia. METHODS/DESIGN: This randomised controlled trial will follow the CONSORT guidelines. Participants will be randomly allocated to the intervention group (receiving a MHFA training course comprising two face to face 6.5 hour sessions run over two days during the intervention period) or a waitlisted control group (not receiving MHFA training during the study). The source population will be undergraduate nursing students at a large university located in Perth, Western Australia. Efficacy of the MHFA training will be assessed by following the intention-to-treat principle and repeated measures analysis. DISCUSSION: Given the known burden of mental health disorders among student populations, it is important universities consider effective strategies to address mental health issues. Providing MHFA training to students offers the advantage of increasing mental health literacy, among the student population. Further, students trained in MHFA are likely to utilise these skills in the broader community, when they graduate to the workforce. It is anticipated that this trial will demonstrate the scalability of MHFA in the university environment for pre-service nurses and that implementation of MHFA courses, with comprehensive evaluation, could yield positive improvements in the mental health literacy amongst this target group as well as other tertiary student groups. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000861651 .

Searching for answers and validation: Australian women's experiences of coping with the adverse sexual effects of antidepressants.

Sexual difficulties relating to selective serotonin reuptake inhibitor (SSRI) medication have an impact on quality of life and are a common cause for non-adherence to medication. While most research has focussed on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the adverse sexual effects of SSRIs. This qualitative study, using Interpretive Phenomenological Analysis (IPA), investigated the experiences of 10 Australian women currently coping with the adverse sexual effects ofthis antidepressant by conducting semi-structured interviews. This paper presents one major theme from the study and reports the findings related to women's self-reported experiences of interacting with GPs in their search for answers and validation of their concerns. Findings from the study add to the current literature by providing an insight into how interactions with GPs impact on women's abilities to cope with adverse sexual effects. Empathic discussions and shared decision-making between GPs and women can provide the opportunity to improve the management of the adverse sexual effects of SSRIs and may lead to improved outcomes for women.

Women's experiences of coping with the sexual side effects of antidepressant medication.

A growing body of evidence has highlighted the sexual side effects of selective serotonin reuptake inhibitor (SSRI) medication. Whilst most of the research has focused on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the SSRI-related sexual side effects. The objective of this study was to explore women's experiences of coping with the sexual side effects of SSRI medication and interpretative phenomenological analysis was employed for an in-depth exploratory study of a sample of 10 women. Four broad themes emerged which are discussed under the following headings: searching, suffering in silence, trying to resolve and accepting what is. The themes provide an insight into the different strategies used by women to cope with the sexual side effects of SSRI medication and highlight the importance of contextualising these difficulties as part of an overall approach to improve the management and treatment of SSRI-related sexual side effects.

A clinical case study of the use of ecological momentary assessment in obsessive compulsive disorder.

Accurate assessment of obsessions and compulsions is a crucial step in treatment planning for Obsessive-Compulsive Disorder (OCD). In this clinical case study, we sought to determine if the use of Ecological Momentary Assessment (EMA) could provide additional symptom information beyond that captured during standard assessment of OCD. We studied three adults diagnosed with OCD and compared the number and types of obsessions and compulsions captured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) compared to EMA. Following completion of the Y-BOCS interview, participants then recorded their OCD symptoms into a digital voice recorder across a 12-h period in reply to randomly sent mobile phone SMS prompts. The EMA approach yielded a lower number of symptoms of obsessions and compulsions than the Y-BOCS but produced additional types of obsessions and compulsions not previously identified by the Y-BOCS. We conclude that the EMA-OCD procedure may represent a worthy addition to the suite of assessment tools used when working with clients who have OCD. Further research with larger samples is required to strengthen this conclusion.

Brown-Vialetto-Van Laere syndrome: case report and literature review.

We describe a case of the Brown-Vialetto-Van Laere syndrome, which is a rare disorder characterized by progressive pontobulbar palsy associated with sensorineural deafness. More than 30 cases have been reported since the first case was described in 1894. We review the literature of this condition, comparing our case with those reported in the literature and emphasizing important features to improve our understanding of this syndrome.

Intravenous methylprednisolone for multiple sclerosis in relapse.

A randomised comparison is made between methylprednisolone, 1 g intravenously daily for 7 days, and a standard ACTH regime for the treatment of multiple sclerosis in acute relapse. It is found that methylprednisolone produces a more rapid clinical improvement than ACTH but confers no longer term benefit when the two treatments are compared at 3 months. It is proposed that intravenous methylprednisolone does have a role to play in the management of a patient with an acute relapse of multiple sclerosis.

Myelopathy in Marfan's syndrome.

A patient with Marfan's syndrome and a myelopathy is reported, and the association of multiple spinal arachnoid cysts noted. It is proposed that the basic connective tissue defect in Marfan's syndrome may predispose to the formation of arachnoid diverticuli and that in this case spinal cord damage was the sequel.

Dilemma of the swollen optic disc: a fluorescein retinal angiography study.

In all of 100 consecutive patients referred for retinal angiography with a clinical diagnosis of probable or possible papilloedema a definite diagnosis was made from neurological assessment, neuroradiological investigations, and follow-up. The cases have been divided into 2 groups--those with proved papilloedema and those which have been called either normal or pseudopapilloedema. In all cases the retinal angiograms showed normal or increased optic disc vascularity and normal or increased early and late disc fluorescence. On the basis of these alone clear differences could be shown between the groups. All cases with papilloedema showed a combination of either excess late fluorescence with excess early fluorescence or excess late fluorescence with excess disc vascularity. Only 2 cases of pseudopapilloedema (both with optic disc drusen) showed this combination, and in both the pattern of disc fluorescence was different from that seen in papilloedema. Retinal angiography therefore seems to be of considerable value in differentiating true from pseudopapilloedema, though this is possible only when each stage of the angiogram is carefully studied.

Brain damage in National Hunt jockeys.

Five National Hunt jockeys have been found to have post-traumatic encephalopathy- three with epilepsy and two with significant intellectual and psychological deterioration. Closer supervision is needed.