Dementia education in a primary school classroom: A pedagogical perspective.

The World Health Organisation recognises the importance of dementia education across all sectors of the population, including children. Previous research has shown that dementia education in schools has positively changed students' knowledge about and attitudes to dementia, however little is known about the process of learning about a complex condition, such as dementia. This paper explores how pupils learn about dementia through a pre-planned educational session in the primary classroom to improve our understanding of the pedagogical approaches required for effective dementia education. Using a participatory video approach, 23 primary 6 pupils (aged 10-11) used iPads to film their experiences of a dementia education session using a resource called Understanding Dementia: Class in a Bag. These videos, along with researcher field notes were combined to create analytical vignettes to illustrate the learning processes and interactions that happened within the classroom. Two weeks later, the pupils were invited to a focus group to view footage of the session and reflect on their experiences and explore the understanding of dementia. The findings highlight the importance of embodied learning within the session, particularly in understanding the experience of living with dementia. By understanding the session from the pupil's perspective, the findings show how pupils developed an empathetic understanding of dementia through play and felt more confident about engaging with and helping people living with dementia in future. This paper provides a new understanding of the process of learning about dementia for primary children, as well as demonstrating the viability of including dementia education within school curriculums internationally.

Understanding female sexual dysfunction, its causes and treatments.

Female sexual dysfunction can greatly affect a woman's quality of life. Affected patients need a comprehensive assessment that includes taking a sexual history, medical evaluation and, if appropriate, a manual examination in order to diagnose, treat or identify factors relevant for each individual woman. There may be biological, psychological, emotional and relationship issues. Any biological factors such as vaginal dryness, pelvic floor dysfunction or chronic pain need to be addressed first to help prevent more complex problems developing. Sexual problems may be the cause of or the result of dysfunctional or unsatisfactory relationships. Psychological and emotional factors can create difficulties in sexual response and, equally, they can be the result of unaddressed or untreated biological/medical issues. Nurses working in urology need to be aware of the physiology involved in sexual response and know which conditions and illnesses are likely to affect sexual functioning and which treatments can help.

Penile Size Dissatisfaction.

BACKGROUND: Men concerned about their penis size often consult professionals working in urology, andrology, surgery, and sexual medicine. AIM: To inform professionals in the sexual medicine field about small penis syndrome as a clinical syndrome and to provide recommendations for treatment. METHODS: This was an overview of the existing literature combined with our extensive clinical experience. RESULTS: Small penis syndrome is a syndrome with psychiatric comorbidities and social consequences that impair life. Men with these concerns tend to be susceptible for treatment that is not evidence based and potentially harmful. CLINICAL IMPLICATIONS: Treatment of men with concerns about penis size should start with a thorough biopsychosocial assessment, followed by extensive psychoeducation, counselling, and psychological interventions, even if surgery is being considered. STRENGTHS & LIMITATIONS: The strength of this study is the concise overview of the existing literature combined with clinical experience which leads to important recommendations. Limitation is that this is not a systematic review. CONCLUSION: Complaints about penis size should be taken seriously, and a thorough biopsychosocial and multidisciplinary assessment is required.

Assessing the Hydrogeomorphic Effects of Environmental Flows using Hydrodynamic Modeling.

Water managers are increasingly using environmental flows (e-flows) as a tool to improve ecological conditions downstream from impoundments. Recent studies have called for e-flow approaches that explicitly consider impacts on hydrogeomorphic processes when developing management alternatives. Process-based approaches are particularly relevant in river systems that have been highly modified and where water supplies are over allocated. One-dimensional (1D) and two-dimensional (2D) hydrodynamic models can be used to resolve hydrogeomorphic processes at different spatial and temporal scales to support the development, testing, and refinement of e-flow hypotheses. Thus, the objective of this paper is to demonstrate the use of hydrodynamic models as a tool for assisting stakeholders in targeting and assessing environmental flows within a decision-making framework. We present a case study of e-flows on the Rio Chama in northern New Mexico, USA, where 1D and 2D hydrodynamic modeling was used within a collaborative process to implement an e-flow experiment. A specific goal of the e-flow process was to improve spawning habitat for brown trout by flushing fine sediments from gravel features. The results revealed that the 2D hydrodynamic model provided much greater insight with respect to hydrodynamic and sediment transport processes, which led to a reduction in the recommended e-flow discharge. The results suggest that 2D hydrodynamic models can be useful tools for improving process understanding, developing e-flow recommendations, and supporting adaptive management even when limited or no data are available for model calibration and validation.

Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study.

BACKGROUND: Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment. This study set out to explore women's experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. METHODS: 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. RESULTS: Four superordinate themes were elicited and used to draft 'better treatment' guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous 'Journey into treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also describes the sometimes demoralising process of 'being in treatment', which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to 'partner support'. 'Professional support' comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer support/helping each other' describes the importance of supportive vaginimus networks and sharing tips with other women. CONCLUSIONS: Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed.

Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis.

IMPORTANCE: Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes. OBJECTIVE: To evaluate the importance of the skills training component of DBT by comparing skills training plus case management (DBT-S), DBT individual therapy plus activities group (DBT-I), and standard DBT which includes skills training and individual therapy. DESIGN, SETTING, AND PARTICIPANTS: We performed a single-blind randomized clinical trial from April 24, 2004, through January 26, 2010, involving 1 year of treatment and 1 year of follow-up. Participants included 99 women (mean age, 30.3 years; 69 [71%] white) with borderline personality disorder who had at least 2 suicide attempts and/or nonsuicidal self-injury (NSSI) acts in the last 5 years, an NSSI act or suicide attempt in the 8 weeks before screening, and a suicide attempt in the past year. We used an adaptive randomization procedure to assign participants to each condition. Treatment was delivered from June 3, 2004, through September 29, 2008, in a university-affiliated clinic and community settings by therapists or case managers. Outcomes were evaluated quarterly by blinded assessors. We hypothesized that standard DBT would outperform DBT-S and DBT-I. INTERVENTIONS: The study compared standard DBT, DBT-S, and DBT-I. Treatment dose was controlled across conditions, and all treatment providers used the DBT suicide risk assessment and management protocol. MAIN OUTCOMES AND MEASURES: Frequency and severity of suicide attempts and NSSI episodes. RESULTS: All treatment conditions resulted in similar improvements in the frequency and severity of suicide attempts, suicide ideation, use of crisis services due to suicidality, and reasons for living. Compared with the DBT-I group, interventions that included skills training resulted in greater improvements in the frequency of NSSI acts (F1,85 = 59.1 [P < .001] for standard DBT and F1,85 = 56.3 [P < .001] for DBT-S) and depression (t399 = 1.8 [P = .03] for standard DBT and t399 = 2.9 [P = .004] for DBT-S) during the treatment year. In addition, anxiety significantly improved during the treatment year in standard DBT (t94 = -3.5 [P < .001]) and DBT-S (t94 = -2.6 [P = .01]), but not in DBT-I. Compared with the DBT-I group, the standard DBT group had lower dropout rates from treatment (8 patients [24%] vs 16 patients [48%] [P = .04]), and patients were less likely to use crisis services in follow-up (ED visits, 1 [3%] vs 3 [13%] [P = .02]; psychiatric hospitalizations, 1 [3%] vs 3 [13%] [P = .03]). CONCLUSIONS AND RELEVANCE: A variety of DBT interventions with therapists trained in the DBT suicide risk assessment and management protocol are effective for reducing suicide attempts and NSSI episodes. Interventions that include DBT skills training are more effective than DBT without skills training, and standard DBT may be superior in some areas. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00183651.