Women's understandings of sexuality, sex and sexual problems : an interview study.

Background There are a paucity of studies that address women's own understandings of sexuality and sexual problems. Much of the research and theory which underpin current diagnostic criteria for sexual problems is based upon a set of sexual norms which are predicated upon male experience. Moreover, these dominant understandings, entrenched in a perspective that favours the material body, fail to take account of contextual factors of women's experiences. Objectives Within a diverse sample of women: to examine understandings of sexuality and sexual problems; explore the importance of sexual activity using their own definitions; and identify the influence of wider socio-cultural factors upon understandings of sexuality and sexual problems. Methods In-depth semi-structured interviews were conducted with thirteen women recruited from the general public and ten women recruited from a psychosexual clinic aged 23-72 years. Data analysis Data were analysed thematically using the conventions of template analysis within a material-discursive framework. Findings The findings of this study suggest that women's understandings of sexuality, sex and sexual problems should be understood as bodily 'experienced' and socially and psychologically mediated. Participants also appear to be influenced by the relational context of their experience and draw upon a patriarchal explanatory framework to make sense of their own sexual functioning and satisfaction. Conclusions This study poses a challenge to the recent drive to medicalise women's sexual problems via the Female Sexual Dysfunction (FSD) label. The findings dispute current diagnostic criteria for sexual problems which presuppose a highly individualized framework and take very little account of contextual factors. Consequently, this study concludes that such criteria need to consider biological, social, psychological as well as patriarchal and historical factors in determining the meaning and importance of sexuality, sex and sexual problems to women

Solution-Focused Brief Therapy-Enhanced Fatherhood Curriculum Pilot Study: A Comparison of Delivery Methods in Response to the COVID-19 Pandemic

Many fatherhood programs provide curriculum-based peer groups, but the evidence for their effectiveness is limited and prior studies highlight challenges in recruiting and retaining participants. This pilot study aimed to test the effectiveness of a standard fatherhood curriculum enhanced with Solution Focused Brief Therapy (SFBT) using a quasi-experimental design. Study outcomes included father involvement and parenting skills measured immediately post-intervention. A sample of 92 fathers (M age = 35.2) participating in a fatherhood program were recruited to participate in the study. Due to COVID-19, the treatment groups were moved to an online format. Independent samples and paired samples t-test were used to detect group differences and Hedges’s effect sizes were also calculated to examine magnitude of treatment effects. Although the SFBT-enhanced peer group curriculum did not outperform the comparison curriculum, the online version of the SFBT-enhanced curriculum was found to be equivalent to the in-person curriculum. These novel findings suggest that online fatherhood groups may be similarly as effective as in-person groups, which may increase opportunities for access and participation in fatherhood programs

Putting food in the driver’s seat: aligning food-systems policy to advance sustainability, health, and security

Food is a basic need, but seldom a basic policy area. Food systems are widely governed by disconnected policies distributed across a range of sectors including agriculture, education, health, environment, economy, and security. Failure to align food system strategies often results in these disparate policies operating at cross-purposes. Conventional food production and consumption practices contribute to biodiversity decline and climate change, cause diet-related health problems, are associated with worker exploitation, and create national security risks. Drawing on agroecology for cohesive national food strategies can provide benefits across all these sectors: supporting public health, environmental sustainability, economic stability, social cohesion, and national security and sovereignty

Evaluation of SLC11A1 as an inflammatory bowel disease candidate gene

BACKGROUND: Significant evidence suggests that a promoter polymorphism withinthe gene SLC11A1 is involved in susceptibility to both autoimmune and infectious disorders. The aim of this study was to evaluate whether SLC11A1 has a role in the susceptibility to inflammatory bowel disease (IBD) by characterizing a promoter polymorphism within the gene and two short tandem repeat (STR) markers in genetic proximity to SLC11A1. METHODS: The studied population consisted of 484 Caucasians with IBD, 144 population controls, and 348 non-IBD-affected first-degree relatives of IBD patients. IBD subjects were re-categorized at the sub-disease phenotypic level to characterize possible SLC11A1 genotype-phenotype correlations. Polymorphic markers were amplified from germline DNA and typed using gel electrophoresis. Genotype-phenotype correlations were defined using case-control, haplotype, and family-based association studies. RESULTS: This study did not provide compelling evidence for SLC11A1 disease association; most significantly, there was no apparent evidence of SLC11A1 promoter allele association in the studied Crohn's disease population. CONCLUSION: Our results therefore refute previous studies that have shown SLC11A1 promoter polymorphisms are involved in susceptibility to this form of IBD

National Guidelines For The Management Of Pain In Older Adults

Consultation Paper- This guidance document reviews the epidemiology and management of pain in older people via a systematic literature review of published research. The aim of this document is to inform any health professionals in any care settings who work with older adults on best practice for the management of pain and to identify any gaps in the evidence which may require further research

Pharmacy Refill Adherence Compared with CD4 Count Changes for Monitoring HIV-Infected Adults on Antiretroviral Therapy

Analyzing pharmacy and laboratory records from 1,982 patients beginning HIV therapy in southern Africa, Gregory Bisson and colleagues find medication adherence superior to CD4 count changes in identifying treatment failure

The Intensive Diet and Exercise for Arthritis (IDEA) trial: design and rationale

Background: Obesity is the most modifiable risk factor, and dietary induced weight loss potentially the best nonpharmacologic intervention to prevent or to slow osteoarthritis (OA) disease progression. We are currently conducting a study to test the hypothesis that intensive weight loss will reduce inflammation and joint loads sufficiently to alter disease progression, either with or without exercise. This article describes the intervention, the empirical evidence to support it, and test-retest reliability data. Methods/Design: This is a prospective, single-blind, randomized controlled trial. The study population consists of 450 overweight and obese (BMI = 27-40.5 kg/m2) older (age greater than or equal to 55 yrs) adults with tibiofemoral osteoarthritis. Participants are randomized to one of three 18-month interventions: intensive dietary restriction-plus-exercise; exercise-only; or intensive dietary restriction-only. The primary aims are to compare the effects of these interventions on inflammatory biomarkers and knee joint loads. Secondary aims will examine the effects of these interventions on function, pain, and mobility; the dose response to weight loss on disease progression; if inflammatory biomarkers and knee joint loads are mediators of the interventions; and the association between quadriceps strength and disease progression. Results: Test-retest reliability results indicated that the ICCs for knee joint load variables were excellent, ranging from 0.86 - 0.98. Knee flexion/extension moments were most affected by BMI, with lower reliability with the highest tertile of BMI. The reliability of the semi-quantitative scoring of the knee joint using MRI exceeded previously reported results, ranging from a low of 0.66 for synovitis to a high of 0.99 for bone marrow lesion size. Discussion: The IDEA trial has the potential to enhance our understanding of the OA disease process, refine weight loss and exercise recommendations in this prevalent disease, and reduce the burden of disability. Originally published BMC Musculoskeletal Disorders, Vol. 10, No. 93, July 200

Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial

Background: Recently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown. Thus, the policy relevant and clinically important question is: Can we adapt this successful solution to a pervasive public health problem in real-world clinical and community settings? This study aims to develop a systematic, practical, cost-effective diet-induced weight loss and exercise intervention implemented in community settings and to determine its effectiveness in reducing pain and improving other clinical outcomes in persons with knee OA. Methods/Design: This is a Phase III, pragmatic, assessor-blinded, randomized controlled trial. Participants will include 820 ambulatory, community-dwelling, overweight and obese (BMI ≥ 27 kg/m2) men and women aged ≥ 50 years who meet the American College of Rheumatology clinical criteria for knee OA. The primary aim is to determine whether a community-based 18-month diet-induced weight loss and exercise intervention based on social cognitive theory and implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to a nutrition and health attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, mobility, and is cost-effective. Discussion: Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments as recommended by numerous OA treatment guidelines. This study will establish the effectiveness of a community program that will serve as a blueprint and exemplar for clinicians and public health officials in urban and rural communities to implement a diet-induced weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA

Allele-Specific HLA Loss and Immune Escape in Lung Cancer Evolution

Immune evasion is a hallmark of cancer. Losing the ability to present neoantigens through human leukocyte antigen (HLA) loss may facilitate immune evasion. However, the polymorphic nature of the locus has precluded accurate HLA copy-number analysis. Here, we present loss of heterozygosity in human leukocyte antigen (LOHHLA), a computational tool to determine HLA allele-specific copy number from sequencing data. Using LOHHLA, we find that HLA LOH occurs in 40% of non-small-cell lung cancers (NSCLCs) and is associated with a high subclonal neoantigen burden, APOBEC-mediated mutagenesis, upregulation of cytolytic activity, and PD-L1 positivity. The focal nature of HLA LOH alterations, their subclonal frequencies, enrichment in metastatic sites, and occurrence as parallel events suggests that HLA LOH is an immune escape mechanism that is subject to strong microenvironmental selection pressures later in tumor evolution. Characterizing HLA LOH with LOHHLA refines neoantigen prediction and may have implications for our understanding of resistance mechanisms and immunotherapeutic approaches targeting neoantigens. Video Abstract [Figure presented] Development of the bioinformatics tool LOHHLA allows precise measurement of allele-specific HLA copy number, improves the accuracy in neoantigen prediction, and uncovers insights into how immune escape contributes to tumor evolution in non-small-cell lung cancer