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Good sexual health promotes quality of life and coping skills, and this also applies to older adults. This clinical review article presents updated knowledge on older adults' sexuality, normal challenges related to ageing and conjugal relationships, and sexual challenges caused by chronic diseases, adverse effects of medications, and cognitive failure. The review describes measures to improve sexual health. Healthcare personnel should take the initiative to talk about sexual health with older adults.

How patients experience discussing couple relationship problems with general practitioners: an interview study.

BACKGROUND: Couple relationship satisfaction is related to good physical and mental health and longevity. Many patients have discussed or wish to discuss their couple relationship with their general practitioner (GP) and look for personalised care and support when discussing topics they perceive as sensitive. AIM: To explore patient experiences of discussing couple relationship problems in GP consultations. DESIGN & SETTING: Qualitative study employing semi-structured interviews with patients from general practice. METHOD: Individual interviews with 18 patients who had discussed their couple relationship with their GP. Participants were recruited through both social and traditional media, and all interviews were digitally recorded. The purposive sample comprised thirteen women and five men, representing diverse age groups, backgrounds, and relationship problems. All participants identified as heterosexual. We analysed interview data thematically using systematic text condensation. RESULTS: Three main themes emerged: (i) GPs in a facilitating role, not on an assembly line; (ii) Navigating the "elephant in the room"; (iii) GPs as biomedically competent life witnesses. GP continuity was vital in fostering the trust required to discuss sensitive topics, such as relationship issues. Participants valued a biopsychosocial approach which incorporated knowledge of close relationships into medical consultations. They appreciated both GP support and constructive challenges that prompted them to take responsibility for relationship improvements. CONCLUSION: Patients value their GPs' holistic, supportive, and direct approach in addressing couple relationship problems, although they perceive that GPs do not always have sufficient time. They welcome relevant challenges that can drive positive change.

Support systems for cyclists in automated traffic: A review and future outlook.

Interaction with vulnerable road users in complex urban traffic environments poses a significant challenge for automated vehicles. Solutions to facilitate safe and acceptable interactions in future automated traffic include equipping automated vehicles and vulnerable road users, such as cyclists, with awareness or notification systems, as well as connecting road users to a network of motorised vehicles and infrastructure. This paper provides a synthesis of the current literature on communication technologies, systems, and devices available to cyclists, including technologies present in the environment and on motorised interaction partners such as vehicles, and discusses the outlook for technology-driven solutions in future automated traffic. The objective is to identify, classify, and count the technologies, systems, and devices that have the potential to aid cyclists in traffic with automated vehicles. Additionally, this study aims to extrapolate the potential benefits of these systems and stimulate discourse on the implications of connected vulnerable road users. We analysed and coded 92 support systems using a taxonomy of 13 variables based on the physical, communicational, and functional attributes of the systems. The discussion frames these systems into four categories: cyclist wearables, on-bike devices, vehicle systems, and infrastructural systems, and highlights the implications of the visual, auditory, motion-based, and wireless modes of communication of the devices. The most common system was cyclist wearables (39%), closely followed by on-bike devices (38%) and vehicle systems (33%). Most systems communicated visually (77%). We suggest that interfaces on motorised vehicles accommodate cyclists with visibility all around the car and incorporate two-way communication. The type of system and the effect of communication modality on performance and safety needs further research, preferably in complex and representative test scenarios with automated vehicles. Finally, our study highlights the ethical implications of connected road users and suggests that the future outlook of transport systems may benefit from a more inclusive and less car-centred approach, shifting the burden of safety away from vulnerable road users and promoting more cyclist-friendly solutions.

(Mis-)use of standard Autopilot and Full Self-Driving (FSD) Beta: Results from interviews with users of Tesla's FSD Beta.

Tesla's Full Self-Driving Beta (FSD) program introduces technology that extends the operational design domain of standard Autopilot from highways to urban roads. This research conducted 103 in-depth semi-structured interviews with users of Tesla's FSD Beta and standard Autopilot to evaluate the impact on user behavior and perception. It was found that drivers became complacent over time with Autopilot engaged, failing to monitor the system, and engaging in safety-critical behaviors, such as hands-free driving, enabled by weights placed on the steering wheel, mind wandering, or sleeping behind the wheel. Drivers' movement of eyes, hands, and feet became more relaxed with experience with Autopilot engaged. FSD Beta required constant supervision as unfinished technology, which increased driver stress and mental and physical workload as drivers had to be constantly prepared for unsafe system behavior (doing the wrong thing at the worst time). The hands-on wheel check was not considered as being necessarily effective in driver monitoring and guaranteeing safe use. Drivers adapt to automation over time, engaging in potentially dangerous behaviors. Some behavior seems to be a knowing violation of intended use (e.g., weighting the steering wheel), and other behavior reflects a misunderstanding or lack of experience (e.g., using Autopilot on roads not designed for). As unfinished Beta technology, FSD Beta can introduce new forms of stress and can be inherently unsafe. We recommend future research to investigate to what extent these behavioral changes affect accident risk and can be alleviated through driver state monitoring and assistance.

Sociotechnical Factors Supporting Mobile Phone Use by Bus Drivers.

OCCUPATIONAL APPLICATIONSResults of a survey of drivers working for two bus companies in Norway suggest that 20% of drivers sometimes use a mobile phone while driving, even though it is not permitted. Sociotechnical analysis of the system surrounding drivers at one of the companies elicited ways in which social and technical factors combined to support mobile phone use by bus drivers. These factors were arranged under four themes: increased societal dependence on technology; developments in bus driver culture; the need for bus drivers to resolve conflicting goals; and a lack of belief in adverse consequences of using mobile phone while driving. Our findings (i) support claims that driver-centered analyses of mobile phone use or other traffic safety challenges are an insufficient basis for the development of measures and should be supplemented by sociotechnical analyses; and (ii) can inspire the design of more comprehensive measures to help reduce mobile phone use and road safety risks.

Background: Sociotechnical measures could supplement traditional risk management measures and further reduce risks of collisions involving heavy vehicles. Such measures can be identified using methods rooted in sociotechnical systems theory, which considers that people work in systems comprising multiple social and technical elements that interact to create emergent properties and conditions that influence valued system outcomes. Purpose: To investigate the potential of sociotechnical measures in helping to reduce road risks, we identified how social and technical factors combine to influence mobile phone use by bus drivers working at a company in Norway. Method: A survey of ∼600 drivers was completed, followed by focus group interviews with managers and drivers and one-on-one or group interviews with drivers. The interviews were structured using a sociotechnical analysis framework. Results: Twenty percent of drivers reported using their phone while operating a bus, even though such use was against company guidelines. Almost all drivers took their phone with them when they drove, and 40% of those who said they never used their phone while driving could still hear incoming calls and messages. Analysis from nine interviews with 26 drivers suggested that phone use by drivers operating buses is supported by interacting sociotechnical factors due to an increased societal dependence on technology, developments in bus driver culture, a need for bus drivers to resolve conflicting goals at work, and a lack of consequences for drivers using mobile phone use while driving. Conclusions: Limited consideration of the sociotechnical ecosystems surrounding bus drivers can contribute to their mobile phone use and thereby to potential problems of attention and awareness while driving. Sociotechnical approaches should be developed using participative design to reduce phone use while driving, especially to promote openness and information sharing and support bus drivers in the field as they strive to resolve conflicting goals.

How do general practitioners handle couple relationship problems in consultations? A focus group study.

BACKGROUND: Couple relationship problems are common and associated with health problems. The aim of this study was to explore general practitioners' (GPs') experiences, expectations, and educational needs when dealing with couple relationship problems in consultations. METHODS: We conducted an exploratory qualitative study by carrying out 3 semistructured focus group interviews with 18 GPs. We used systematic text condensation for the analyses. RESULTS: Participants shared their experiences of handling couple relationship problems in consultations. Three main themes emerged: (i) pragmatic case-finding: golden opportunities to reveal patients' couple relationship problems; (ii) conceptual and role confusion; (iii) professional competence and personal experience. While issues in relationships could serve as an explanation for relevant clinical problems, some GPs questioned whether relationship issues are strictly medical. All participants had engaged in individual supportive therapy, but none saw themselves as therapists. The interviews revealed that an individual supportive focus might lead to a consolidation of 1 partner's view, rather than challenging their position. Long-term doctor-patient relationships made it easier to talk about these issues. CONCLUSIONS: This study revealed several paradoxes. GPs are confident in offering individual supportive therapy for couple relationship issues but should be aware of substantial pitfalls such as side-taking and constraining change. Despite dealing with relationship problems, GPs do not see themselves as therapists. They use professional and personal experience but would benefit from increasing their skills in cognitive restructuring promoting behavioural flexibility facing relationship problems.

Couple relationship problems are common and often raised in general practitioner (GP) consultations as they are associated with health problems. We lack knowledge about what experiences, expectations, and educational needs GPs have when dealing with these problems. In 2020, we interviewed 18 GPs about how they handle couple relationship problems in their practice. Three main themes emerged: (i) Patients seldom present their relationship as the main problem. GPs conduct pragmatic case-finding to reveal relational problems that might be connected to, or be a risk factor for, health problems. (ii) GPs deal with couple relationship problems in several ways. Some think that they are not a medical problem, while others take a more holistic approach. In both cases, GPs lack the tools to assess couple relationship problems and to offer brief interventions. (iii) The most experienced doctors emphasized that their professional and personal experience qualified them to support their patients. Continuity in the doctor­patient relationship was also considered important. We revealed that taking a biopsychosocial approach can be challenged by searching for biomedical causes for problems. GPs should be aware of the pitfalls of individual supportive therapy in dealing with couple relationship issues, such as taking sides and impeding change.

Bus stop design and traffic safety: An explorative analysis.

One way to prioritize public transport over private vehicle mobility, is to implement curbside rather than layby bus stop designs. There is, however, uncertainty about the consequences of implementing curbside rather than layby stops for traffic collision risks. To begin investigating this issue, we describe an exploratory analysis in which national data describing bus stops, road properties, traffic collisions and built-up areas were merged based on geographical location. Analysis of the resulting data set suggests that the relative rates of traffic collisions resulting in personal injury within 60 m of the bus stop, is higher for curbside than for layby stops in built-up areas (0.32 vs. 0.22 collisions per ten million passing vehicles, respectively). Our analyses suggest that the higher risk of nearby collisions for curbside stops is not necessarily due to bus stop design, but rather because they tend to be located closer to junctions and side roads, where collisions are more likely. Our data are not consistent with hypotheses that curbside stops are associated with greater shares of head-on or rear-end collisions than layby stops, nor that layby stops are associated with greater shares of side-on collisions than curbside stops. The limitations of this exploratory analysis, and of the use of national-level data for studying the effects of bus stop design on collision risk, are related to lack of control of bus stop design features other than curbside vs. layby, statistical power, data registration and compromises made when coupling data based on geographical location. Future work should attempt to build on our approach, and supplement database analyses with analysis of in-depth reports of bus stop collisions, observations of road user conflicts near bus stops, and before-after studies following conversion from layby to curbside stops or from curbside to layby stops.

Couple relationship problems-a task for the general practitioner? A cross-sectional survey from Norway.

BACKGROUND: A healthy couple relationship is a predictor of good health. There is a lack of knowledge about what role family and couples counselling should have in general practice. OBJECTIVES: To identify the prevalence of patients who have talked, or want to talk, with their general practitioner (GP) about their couple relationship, to investigate what characterizes these patients and to explore whether they believe that couple relationship problems should be dealt with in general practice. METHODS: We conducted a cross-sectional survey in 70 general practices in Norway during spring 2019. A questionnaire was answered by 2178 consecutive patients (response rate 75%) in GP waiting rooms. Data were examined using frequencies and linear and logistic regression models. RESULTS: We included 2097 responses. Mean age was 49.0 years and 61.3% were women. One in four (25.0%) had already talked with their GP about couple relationship problems, while one in three (33.5%) wanted to talk with their GP about their couple relationship problems. These patients more frequently had experience of divorce, poor self-rated health, an opinion that their couple relationship had a significant impact on their health and lower couple relationship quality when adjusted for age, sex, present marital status and children living at home. We found that 46.4% of patients believed that GPs should be interested in their couple relationship problems. CONCLUSION: Relationship problems are frequently addressed in general practice. GPs should be prepared to discuss this issue to facilitate help for couples earlier than they might otherwise expect.