Pedagogical principles and methods underpinning education of health and social care practitioners on experiences and needs of older LGBT+ people: Findings from a systematic review.

BACKGROUND: There is a growing awareness of the need for LGBT + competency training to ensure that the health and social care services offered to older LGBT + people is affirmative and gender sensitive. OBJECTIVE: To conduct a synthesis of the literature that describes the pedagogical principles, curriculum content and methods (teaching and assessment) used to educate health and social care practitioners on the experiences and needs of older LGBT + people. DESIGN: Systematic thematic review of literature. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, EMBASE, Web of Science, Social Sciences Index, ERIC. METHOD: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, this review examined peer-reviewed papers published in English, prior to April 2018 that addressed pedagogical and curriculum issues on the inclusion of needs and experiences of older LGBT + people. RESULTS: The combined searches yielded 2214 papers of which 17 papers were eligible for inclusion, 10 discussion papers and 7 evaluation studies. Analysis identified the following themes: i) Acknowledging the wider historical context of older LGBT + people's lives; ii) Recognising that older LGBT + people are not a homogenous group; iii) Incorporating a multitude of theories and models from different perspectives; iv) Alerting practitioners to the health issues and disparities facing older LGBT + people; v) Including content that supports inclusive care for older LGBT + people; vi) Addressing barriers to older LGBT + people accessing health care; vii) Interactive activities are the preferred pedagogical strategy; viii) Involving older LGBT + people in curriculum development is a core principle; and ix) Mandatory education is not always the solution. CONCLUSION: As the field matures there is a need for more exploration of curriculum principles, assessment strategies and strategies to overcome barriers to the inclusion of issues experienced by older LGBT + people within curricula.

Tadalafil treatment had a modest effect on endothelial cell damage and repair ability markers in men with erectile dysfunction and vascular risk.

The number of the circulating angiogenic cells (CACs) and colony forming units (CFUs) derived from cultured circulating mononuclear cells (MNCs) represents a laboratory surrogate for endothelial cell repair ability. The serum of men with erectile dysfunction (ED) and vascular risk factors (VRFs) showed an increased level of endothelial cell damage/dysfunction markers and reduced the numbers of CACs and CFUs derived from the cells of healthy men. We analyzed whether treating men with ED and VRFs with the selective phosphodiesterase type 5 inhibitor tadalafil improved the endothelial cell repair ability and reduced the levels of the serum markers of endothelial cell damage/dysfunction. MNCs from healthy men were cultured with 20% serum from 36 ED patients to obtain CACs and CFUs. The ED patients were evaluated before and after 4 weeks of treatment with tadalafil (20 mg every other day) or with a placebo. The tadalafil treatment improved erectile function (P = 0.0028), but had no effect on the inhibitory effects of serum from ED patients on the CACs and CFUs derived from healthy men. The levels of endothelin-1 (P = 0.011) and tissue type plasminogen activator (P = 0.005) were reduced after treatment compared to baseline and those of the placebo group, whereas no changes were observed in the E-selectin levels. The tadalafil treatment in the ED patients with VRFs resulted in only a modest effect on the laboratory measures of the endothelial cell damage/dysfunction and repair ability. The proposed beneficial effect of phosphodiesterase type 5 inhibition on vascular homeostasis requires further analysis.

Physical exercise at high altitude is associated with a testicular dysfunction leading to reduced sperm concentration but healthy sperm quality.

OBJECTIVE: To explore the effect of physical exercise at high altitudes (HA) on male reproductive system. DESIGN: Prospective study. SETTING: Andrology Clinic, University of L'Aquila, Italy. PATIENT(S): Seven male mountaineers involved in an expedition at 5,900 m. INTERVENTION(S): Semen analysis, sperm DNA fragmentation with flow cytometry, and reproductive hormone levels. MAIN OUTCOME MEASURE(S): Hormone levels were evaluated at sea level (SL) at baseline (SL-pre), after 22 days of exercise at HA (intermediate), and after 10 days upon reaching SL (SL-post). Sperm parameters, percentage of sperm with fragmented DNA, and body composition measures were evaluated at SL-pre and at SL-post. RESULT(S): A reduction of sperm concentration, of body mass index (BMI), of waist circumference, and of percentage of body fat was observed at SL-post compared with SL-pre values. Increased levels of FSH and PRL were observed at the intermediate point, and normalized at SL-post, whereas T was higher at SL-post compared with SL-pre levels. CONCLUSION(S): Physical exercise at HA is associated with a testicular dysfunction leading to a reduced sperm concentration probably through an altered spermiation. The improved body composition after physical exercise might explain the higher T levels observed after the expedition.