A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer.

PURPOSE: Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. METHODS: Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). RESULTS: Twenty participants were 26-71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. CONCLUSIONS: According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.

Outcomes of a systematically designed strategy for the implementation of sex education in Dutch secondary schools.

This study examines the effects of a systematically designed innovation strategy on teachers' implementation of a sex education curriculum and its related determinants. A quasi-experimental group design was used to assess the effectiveness of the innovation strategy. Teachers filled in questionnaires on the determinants of curriculum implementation and kept a record of their actual use of the curriculum. We measured several determinants, including teachers' curriculum-related beliefs, characteristics of the interactive context and characteristics of the innovation strategy. Participating teachers (n=109) carried out most of the activities they were supposed to (81%). Multiple linear regression indicated that their outcome beliefs and perceived instrumentality of the curriculum best predicted extent of use of the curriculum (R2=0.23). The innovation strategy had a positive impact not only on extent of use (18.4 activities versus 15.8 activities; t=2.3, P<0.05), but also on teachers' curriculum-related beliefs. It can be concluded that a systematically designed innovation strategy has the potential to produce significant changes in classroom-based sex-education practices. Not only did teachers exposed to the innovation strategy implement more of the curriculum than teachers in the control group, also teachers' beliefs and expectations about student learning constituting their classroom behavior changed accordingly.

Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process.

Endoscopy in lye burns of oesophagus and stomach.

Upon ingestion of lye and its compounds severe corrosive lesions may develop not only in the oesophagus but also of the stomach. These are frequently not recognized until life-threatening complications have set in. Two case histories are reported to point to the need for early endoscopic examinations. Brown-black discoloration of the mucosa of the stomach signifies necrosis through the thickness of the wall which is an indication for immediate resection.

Organic micropollutants in air and water. Sampling, gas chromatographic-mass spectrometric analysis and computer identification.

Organic micropollutants are sampled by dynamic enrichment on a porous polymer column and subsequently thermally eluted in a flow of helium. The eluted compounds enter gas chromatograph inlet and then pass into two parallel glass capillary columns with different stationary phases, in which they are separated. The separated compounds are detected by gas chromatographic (GC) detectors and by a mass spectrometer that is connected to one or other of the two capillary columns by "heart cutting" systems. The GC and mass spectrometric (MS) signals are fed via interfaces into a minicomputer which controls the MS scan and performs data acquisition, reduction and treatment on-line and off-line. The resulting GC and MS data are displayed on a line printer or a visual display unit. The minicomputer is connected by a telephone line to an IBM 370/165 computer, where a library search system has been implemented. Some difficulties encountered, data on the sampling recovery of model compounds and the identification of compounds in air and water samples by GC-MS data and library searches are discussed.

[Child of the 4th world]. / L'enfant du quart-monde

The authors underlines some aspects of the life of children from the Fourth World, which explain their unavoidable failure in the actual scholar system. The social and cultural exclusion experienced in their milieu causes a lack of self confidence in the parents, a fact which disturbs heavily the physical, affective and intellectual development of the children, as well as their socialisation.