Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community.

Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.

Patient satisfaction with transgender health services.

Measuring patient satisfaction (i.e., patients' subjective evaluation of health care services received) is increasingly important in assessing health care outcomes because of the current emphasis on greater partnership between providers (therapist, doctor, staff) and consumers (patients) in health care. In care of transgender persons, achieving good patient satisfaction is particularly challenging given the primary role mental health professionals play as arbiters of who has access to sex reassignment and when such candidates are ready. Dependence on a mental health professional in this "gate-keeping" role is perceived by some members of the transgender community as unnecessarily pathologizing. This study compared satisfaction ratings of 180 transgender and 837 other sexual health patients with psychotherapeutic, psychiatric, and sexual medicine services provided at a university-based sexual health clinic. Five consecutive surveys conducted during 1993-2002 showed high patient satisfaction. We found few significant differences between transgender and other sexual health patients, except that in 1995, transgender patients had higher satisfaction on their perceived ability to handle the problems that originally had led them to therapy. Survey results helped target areas in need of improvement (e.g., friendliness and courtesy of staff, handling of phone calls), and efforts by the providers to improve services resulted in significant increases in patient satisfaction. These findings put individual complaints in perspective and showed that despite the challenges inherent in providing transgender care good satisfaction can be achieved. We encourage providers to implement quality assurance and improvement procedures to give patients the opportunity to provide feedback and have a voice in shaping their own health care.

Meta-analysis of the effectiveness of HIV prevention interventions for women.

The present study is a meta-analysis of the effectiveness of HIV prevention interventions for women in the USA. Twenty-four articles from 1989-1997 were included. We evaluated five ethnic groupings (All Ethnicities Combined, African-American, White, Hispanic and a Mixed Ethnicity group) over four time periods (post-test, less than two months after the intervention, 2-3 months after the intervention and 6-24 months after the intervention) on three HIV-related sexuality outcome variables (HIV/AIDS knowledge, self-efficacy and sexual risk reduction behaviour). The HIV interventions appear effective at improving knowledge about HIV/AIDS and increasing sexual risk reduction behaviours for all ethnicities examined at all follow-up periods, with one exception. The findings for self-efficacy are less consistent. The interventions were less consistently effective for African-American women, for whom significant improvements in feelings of self-efficacy were only seen six months or longer after the intervention. The present analysis elucidates ethnic differences which may have previously been obscured while demonstrating convincingly that HIV interventions are generally effective for women of many different ethnicities.

Fat phobia scale revisited: the short form.

OBJECTIVE: To develop a shortened form of the original 50-item fat phobia scale. METHOD: The first factor from the original fat phobia scale-undisciplined, inactive and unappealing-was identified as a potential short form of the scale. A new sample of 255 people completed the original 50-item scale. The reliability of a shortened 14-item version of the scale was tested and compared to that of the full scale using both the new sample and the original sample of 1135 study participants. RESULTS: The fat phobia scale-short form demonstrated excellent reliability in both samples and was strongly correlated with the 50-item scale. Mean and 90th percentile scores are given for both the long and short versions of the scale. CONCLUSION: The shortened fat phobia scale is expected to increase the utility of the measure in a diverse array of research and clinical settings. Future research should focus on developing scale norms for the general population and conducting research on fat phobia in males and among different ethnic groups.

Adult and pediatric CPR: attitudes and expectations of health professionals and laypersons.

Nationally accepted resuscitation courses offer few guidelines for terminating unsuccessful cardiopulmonary resuscitation (CPR). Data were collected from 305 physicians and nurses in 1988/1989 and 401 physicians, nurses, and laypersons in 1998/1999 to assess their attitudes and expectations about adult and pediatric CPR. Respondents felt pediatric CPR efforts should continue longer than adult CPR efforts. Respondents in 1998/1999 felt CPR efforts did not need to continue as long as the 1988/1989 respondents felt. Laypersons thought that 52% of adult CPRs and 63% of pediatric CPRs were successful. Although lower than laypersons' expectations, health care professionals' expectations of CPR success were also unrealistic; physicians believed 24% of adult and 41% of pediatric CPRs were successful and nurses believed 30% of adult and 45% of pediatric CPRs were successful. Health care professionals also indicated that they had a clearer idea of when to terminate adult CPR than pediatric CPR.

Tattoos: their relationship to trauma, psychopathology, and other myths.

OBJECTIVE: The purpose of this study was to examine the relationship between tattoos and reason for presentation to a community hospital emergency department (ED): injury, illness, or a psychiatric/chemical dependency problem. In addition, to assess contemporary beliefs about tattoos, ED staff and patients were surveyed about their attitudes toward and personal experience with tattoos. Demographic characteristics of participants also were evaluated relative to tattoos. METHODS: All patients seen in the ED during two 24-hour periods in winter 1999 were surveyed about tattoos in a personal interview. Hospital staff who regularly interact with ED patients were asked the same questions. Data were collected on 294 patients and 289 staff members. Diagnoses were recorded for all patients, then coded as an injury, illness, or psychiatric/chemical dependency complaint. RESULTS: In the 16-35 years age group, 35% of patients and 19% of staff had tattoos. In the 36-50 years age group, 28% of patients and 11% of staff had tattoos, and the 51-65 group had similar percentages: 6% of patients and 5% of staff had tattoos. Having a tattoo was not related to presenting complaint. Age was a significant predictor of attitudes regarding tattoos: Younger people had a more positive attitude. Significantly more smokers (31%) than nonsmokers (13%) had tattoos. Education was negatively related to having a tattoo. Gender was not significantly related to having a tattoo or to the number of tattoos a person had. CONCLUSION: A surprisingly large percentage of young patients presenting to the ED had tattoos. No relationship was found between having a tattoo and nature of chief complaint.

Masculinity scores as an artifact of feminist attitude: evidence from a study of lesbians and college women.

Data from a sample of lesbian women (n = 58) and college women (n = 129) are analyzed to examine the relationship between feminism (AWS), sexual orientation, and a PAQ-defined masculinity score. While lesbians have higher M scores, they also have very high AWS scores. When AWS is controlled in a multiple regression analysis, the difference on M scores between the two sexual orientation groups disappears. The results support the hypothesis that high masculinity scores for women represent strong self-confidence and independence, characteristics of those with positive feminist outlooks. We also argue that measures of traits such as independence and expressiveness need to be labeled as such, and not as "masculinity" or "femininity."

Transgender HIV prevention: implementation and evaluation of a workshop.

Virtually no HIV prevention education has specifically targeted the transgender community. To fill this void, a transgender HIV prevention workshop was developed, implemented and evaluated. A 4 h workshop, grounded in the Health Belief Model and the Eroticizing Safer Sex approach, combined lectures, videos, a panel, discussion, roleplay and exercises. Evaluation using a pre-, post- and follow-up test design showed an increase in knowledge and an initial increase in positive attitudes that diminished over time. Due to the small sample size (N = 59) and limited frequency of risk behavior, a significant decrease in unsafe sexual or needle practices could not be demonstrated. However, findings suggested an increase in safer sexual behaviors such as (mutual) masturbation. Peer support improved significantly. Future prevention education should make special efforts to target the more difficult-to-reach, high-risk subgroups of the transgender population.

Therapeutic uses of sexually explicit materials in the United States and the Czech and Slovak Republics: a qualitative study.

This study investigates the reflections of 279 U.S. and Czech and Slovak mental health and health professionals about their use of sexually explicit materials. Professionals were 2.6 times as likely to cite specific instances when their use of sexually explicit materials was useful with their clients and students than they were to cite instances when such materials were not useful. In addition, no significant differences were observed between the ways in which U.S. and Czech and Slovak mental health and health professionals evaluated these materials. The article presents several suggestions for the judicious and efficacious use of sexually explicit materials in therapy or in the classroom in either Western or Central European settings.

Attitudes of U.S. and Czech/Slovak mental health and health professionals toward five types of sexually explicit materials.

Mental health and health professionals' attitudes toward sexually explicit materials in the U.S. and Czech/Slovak Republics were investigated. An instrument measuring attitudes toward educational, soft-core, hard-core, violence, and bizarre/paraphiliac sexually explicit materials was administered to sexologists, psychologist/counselors, and medical professionals. These professionals were attending conferences in the U.S. and the Czech/Slovak Republics between November 1992 and September 1993. Mental health and health professionals had the most favorable attitudes toward educational sexually explicit materials followed by soft-core and hard-core materials, respectively. They had unfavorable attitudes toward violent and bizarre/paraphiliac sexually explicit materials, with particularly negative attitudes toward violent materials. Analysis of covariance showed that strength of religious conviction was a significant covariate; thus professionals with stronger religious conviction had more negative attitudes toward all five types of sexually explicit materials. When controlling for strength of religious conviction: (i) sexologists had more positive attitudes toward most types of sexually explicit materials; (ii) Czech professionals generally had more positive attitudes toward such materials than their U.S. counterparts; and (iii) there were few differences between female and male professionals in their reported attitudes. While previous literature has reported gender differences in attitudes toward sexually explicit materials, findings from this study suggest that this effect may be due to differences in religiosity among women and men, namely, that women tend to be more religious.

The safety of dorsal penile nerve block for neonatal circumcision.

BACKGROUND: Dorsal penile nerve block (DPNB) was first described for use in neonatal circumcision in 1978. Since then, many studies have documented its effectiveness in alleviating pain in newborns undergoing circumcision. In 1989, the American Academy of Pediatrics acknowledged that DPNB may relieve the pain and stress of circumcision but stopped short of endorsing its routine use in this procedure, citing lack of data on its safety. METHODS: To determine the types and rates of complications from DPNB used for neonatal circumcision, the authors conducted a retrospective review of hospital records of 1358 circumcised male infants delivered at an urban medical center during a 1-year period. RESULTS: Of the 1358 records reviewed, 1222 (90%) had sufficient documentation to be included in the study. DPNB was used in 1022 (84%) of the circumcisions. Complications occurred in 12 cases (11 with small ecchymoses at injection sites and one with excessive bleeding from the needle stick), for a rate of 1.2%. No cases of lidocaine toxicity, voiding delay, or vascular compromise were noted. There was a trend toward increased incidence of injection-site hematomas with the Plastibell as compared with the Gomco technique (P = .07). There were no significant differences in complication rates for DPNB performed by less experienced operators (eg, medical students and residents) compared with more experienced operators (staff physicians). CONCLUSIONS: This study corroborates findings of smaller case studies, indicating that DPNB is associated with a low rate of minor complications.

The relation of gender and sexual orientation to measures of masculinity, femininity, and androgyny: a further analysis.

Data from a survey of 58 gay men and 58 lesbians are compared to college men and women on Spence and Helmreich's (1978) Personality Attributes Questionnaire measures of masculinity, femininity, and androgyny. Lesbians had higher M scores than college women, and gay men had lower M scores than college men, with F scores being similar across sexual orientation groups, within gender. Androgyny measures differed only by gender, not by sexual orientation. Further analysis shows that lesbians' high M scores come largely from their high self-ratings as independent, while college men's high M scores reflect strong competitiveness. Questions are raised about the validity of these measures for comparing these groups.