Sexual Functioning in Men With and Without Disabilities: Findings From a Representative Sample of Australian Men.

INTRODUCTION: Studies on sexual function in men with disabilities have mainly relied on clinical samples; population-based evidence on this topic is limited. AIM: The aim of this study was to compare aspects of sexual function between disabled and nondisabled men using a representative sample. METHODS: We used data from Ten to Men, a national cohort study of Australian men aged 18-55 years. We first compared the prevalence of 15 sexual function-related difficulties in disabled vs non-disabled men. Next, we used Poisson regression to examine associations between disability and sexual function. The main analytic sample had 8,496 men. Weights and adjustments appropriate to the sampling methodology were applied. Models adjusted for potential confounders. Results were reported as prevalence ratios (PRs). P values of 1.00 for disability; associations were statistically significant except "partner experienced sexual difficulties" (PR = 1.23; 95% CI = 0.99-1.53; P = .058) and "orgasmed too early" (PR = 1.16; 95% CI = 1.00-1.35; P = .050). "Presence of discomfort/pain" had the largest adjusted PR for disability (PR = 2.77; 95% CI = 1.89-4.06; P < .001). CLINICAL IMPLICATION: This population-based analysis on the relationship between disability and sexual function contextualizes evidence from clinical studies. Findings suggest that disparities between men with and without disability exist but are not uniform across different aspects of sexual function. STRENGTHS & LIMITATIONS: Two major strengths of this study are that the sample included a nondisabled reference group and results are generalizable to Australian men. A key limitation is that disability and sexual function measures are self-reported. CONCLUSION: This study provides a broad foundation of population-based evidence about sexual function in men with disabilities, relative to men without, showing positive associations between disability and 13 of 15 sexual difficulties. Bollier A-M, King T, Shakespeare T, et al. Sexual Functioning in Men With and Without Disabilities: Findings From a Representative Sample of Australian Men. J Sex Med 2019;16:1749-1757

Does parkland influence walking? The relationship between area of parkland and walking trips in Melbourne, Australia

Background : Using two different measures of park area, at three buffer distances, we sought to investigate the ways in which park area and proximity to parks, are related to the frequency of walking (for all purposes) in Australian adults. Little previous research has been conducted in this area, and results of existing research have been mixed. Methods : Residents of 50 urban areas in metropolitan Melbourne, Australia completed a physical activity survey (n = 2305). Respondents reported how often they walked for &gt;=10 minutes in the previous month. Walking frequency was dichotomised to \u27less than weekly\u27 (less than 1/week) and \u27at least weekly\u27 (1/week or more). Using Geographic Information Systems, Euclidean buffers were created around each respondent\u27s home at three distances: 400metres (m), 800 m and 1200 m. Total area of parkland in each person\u27s buffer was calculated for the three buffers. Additionally, total area of \u27larger parks\u27, (park space &gt;= park with Australian Rules Football oval (17,862 m2)), was calculated for each set of buffers. Area of park was categorised into tertiles for area of all parks, and area of larger parks (the lowest tertile was used as the reference category). Multilevel logistic regression, with individuals nested within areas, was used to estimate the effect of area of parkland on walking frequency. Results : No statistically significant associations were found between walking frequency and park area (total and large parks) within 400 m of respondent\u27s homes. For total park area within 800 m, the odds of walking at least weekly were lower for those in the mid (OR 0.65, 95% CI 0.46-0.91) and highest (OR 0.65, 95% CI 0.44-0.95) tertile of park area compared to those living in areas with the least amount of park area. Similar results were observed for total park area in the 1200 m buffers. When only larger parks were investigated, again more frequent walking was less likely when respondents had access to a greater amount of park area. Conclusions : In this study we found that more park area in residential environments reduced the odds of walking more frequently. Other area characteristics such as street connectivity and destinations may underlay these associations by negatively correlating with park area. <br /

Mental health of adolescents:variations by disability and borderline intellectual functioning and disability

Adolescence is a period of elevated stress for many young people, and it is possible that the challenges of adolescence are different for vulnerable groups. We aimed to document the mental health, emotional and behavioral difficulties and suicidal/self-harming behaviors among adolescents with borderline intellectual functioning (BIF) or a disability, compared to those with neither disability nor BIF. Data was drawn from the Longitudinal Study of Australian Children, a nationally representative Australian study. Participants were 2950 adolescents with complete data for Waves 3-6 (years 2008-2014), aged 14-15 years in 2014. Mental health items and self-harming/suicidal thought/behaviors were self-reported. Emotional-behavioral difficulties items came from the Strengths and Difficulties Questionnaire, and were parent-, and adolescent-reported. Results of logistic regression analyses indicate that the emotional-behavioral difficulties of adolescents with either a disability or BIF, was worse than for those with neither disability nor BIF. Additionally, adolescents with a disability reported more symptoms of anxiety and depression, and were more likely to report self-harming/suicidal thoughts and behaviors. Adolescents with BIF or a disability are at higher risk of emotional-behavioral difficulties than those with neither disability nor BIF. There is some evidence that adolescents with a disability are at higher risk of anxiety, self-harming/suicidal thoughts and behaviors than adolescents without a disability

Building Children's Resilience through Respectful and Gender Equitable Relationships Pilot Project: a literature review

The need to pursue cultural change to promote appropriate attitudes and behaviours towards women is being increasingly recognised, both within Australia and globally. The delivery of respectful relationships education (RRE) as part of the Australian curriculum is one significant part of this, and is supported by state-led initiatives to introduce preventive education to address gender-based violence (Department of Education and Training 2015). The City of Melbourne has taken a proactive approach to driving positive cultural change, in an effort to influence appropriate attitudes and behaviours towards women. The Building Children's Resilience through Respectful and Gender Equitable Relationships Pilot Project represents one facet of a broad suite of strategies to promote and normalise gender equity. As identified in the recent evidence paper by Our Watch (Gleeson et.al. 2015), one of the key elements that may predict violence against women is the promulgation and internalisation of "structures, social norms and organisational practices supporting gender inequality" (Gleeson et.al. 2015:7). Recent initiatives such as RRE target school-aged children, but there are no known initiatives aimed at preschool children. Recognising this gap, the City of Melbourne commissioned this research project to scope the potential to intervene in the early childhood years. The scoping project documented in this report presents the results of a rapid, comprehensive and systematic review of empirical evidence from the past 10 years, conducted with the following aims: - to evaluate the effectiveness of interventions to promote gender equity and prevent gender bias among children aged 3-5 years - to synthesise empirical studies regarding the development of gender roles, bias and stereotypes among children aged 3-5 years. This project emphasises a primary prevention approach - that is, it focuses on population-level approaches rather than individual, treatmentfocused action

Conformity to masculine norms: Differences between men with and without a disability

There is a noted paucity of quantitative research examining the interrelationship between masculinity and disability. We analyzed a sample of 12,418 men aged 18 to 55 years from the Australian Longitudinal Study on Male Health (the Ten to Men Study) to investigate associations between disability and conformity to norms of masculinity viewed as traditional in Western societies. To assess masculinity, we used the Conformity to Masculine Norms Inventory–22, both as an overall scale and across 11 different subscales. We found little difference between men with and without a disability on the overall masculinity scale; however, differences were observed on subscales. Men with a disability reported greater conformity to Self-Reliance norms and lower conformity to Pursuit of Status, Heterosexual Presentation, and Primacy of Work. These results suggest that men with disabilities reformulate masculinity to assemble a masculine identity that draws on norms such as self-reliance but places less importance on other elements of masculinity seen as traditional in Western societies

Lithic assemblages of Azokh Cave (Nagorno Karabagh, Lesser Caucasus): Raw materials, technology and regional context

Azokh Cave is a Middle Pleistocene to Holocene site located in Nagorno Karabagh (Lesser Caucasus). The main entrance, Azokh 1, is a large cave that has two geological sequences (lower and upper) with nine geo-archaeological units of which only the upper ones (Units I to V) have a significant archaeological record.  The faunal remains and lithic artefacts in these units indicate aspects of human occupation, and exploitation of, and association with animals.     The lithic artefacts presented here were recovered from Units V, III and II during the 2002 – 2009 excavation seasons. The available chronological data indicates an age between 293 – 100 Ka for these units. The operational chain is incomplete and artefacts found in the cave are primarily end-products dominated by flake-tools. The assemblage of Unit V is composed primarily of simple, unretouched flakes with a minimal presence of retouched flakes and cores. The Unit II lithic assemblage includes a substantial Levallois component, although with fewer cores and retouched flakes. There are very few flake tools in Unit III. While it is still difficult to assign the Unit V assemblage to a techno-typological group or complex (i.e. Acheulean, Mousterian or other local techno-complexes such as the Kudarian), the Unit II assemblage is clearly associated with Mode 3 or the Mousterian techno-complex.Different local and non-local raw materials were exploited in all units for the production of lithic artefacts, although the range of raw materials is more varied in Unit II. Local chert, flint and basalt were used most commonly, probably due to their easy accessibility. Limestone, jasper and sandstone, from local and non-local sources, are present in small quantities in Units V and II. Obsidian is the only raw material that possibly originates from more distant sources. Flint and chert appear to have been preferentially exploited for flake tool production in all units, but the toolmakers show a preference for better quality raw material (flint, basalt, obsidian) for retouched pieces in Units V and II, and for Levallois production in Unit II

Estado del arte de la movilidad académica estudiantil internacional en las instituciones del Nodo Caribe de la Red Colombiana para la Internacionalización de la Educación Superior

El presente artículo compila los resultados de una encuesta sobre movilidad académica estudiantil internacional entrante y saliente realizada en instituciones adscritas al Nodo Caribe de la Red Colombiana para la Internacionalización de la Educación Superior (RCI). La encuesta tuvo como finalidad recopilar información relevante sobre la movilidad académica internacional de los estudiantes en las Instituciones en la Región Caribe Colombiana. Esta encuesta se realizó en el marco de una estrategia de identificación de fortalezas, debilidades, tendencias, incentivos y potencialidades del Nodo Caribe de la RCI, con fines de autoevaluación y mejoramiento del proceso de movilidad académica estudiantil. Se analiza igualmente la estructura de gestión que apoya los procesos de movilidad al interior de las instituciones. Palabras clave: movilidad académica internacional, buenas prácticas de movilidad, incentivos de movilidad académica

A longitudinal study examining changes in street connectivity, land use, and density of dwellings and walking for transport in Brisbane, Australia

Background: Societies face the challenge of keeping people active as they age. Walkable neighborhoods have been associated with physical activity, but more rigorous analytical approaches are needed. Objectives: We used longitudinal data from adult residents of Brisbane, Australia (40–65 years of age at baseline) to estimate effects of changes in neighborhood characteristics over a 6-y period on the likelihood of walking for transport. Methods: Analyses included 2,789–9,747 How Areas Influence Health and Activity (HABITAT) cohort participants from 200 neighborhoods at baseline (2007) who completed up to three follow-up questionnaires (through 2013). Principal components analysis was used to derive a proxy measure of walkability preference. Environmental predictors were changes in street connectivity, residential density, and land use mix within a one-kilometer network buffer. Associations with any walking and minutes of walking were estimated using logistic and linear regression, including random effects models adjusted for time-varying confounders and a measure of walkability preference, and fixed effects models of changes in individuals to eliminate confounding by time-invariant characteristics. Results: Any walking for transport (vs. none) was increased in association with an increase in street connectivity (+10 intersections, fixed effects OR=1.19; 95% confidence interval (CI): 1.07, 1.32), residential density (+5 dwellings/hectare, OR=1.10; 95% CI: 1.05, 1.15), and land-use mix (10% increase, OR=1.12; 95% CI: 1.00, 1.26). Associations with minutes of walking were positive based on random effects models, but null for fixed effects models. The association between land-use mix and any walking appeared to be limited to participants in the highest tertile of increased street connectivity (fixed effects OR=1.17; 95% CI: 0.99, 1.35 for a 1-unit increase in land-use mix; interaction p-value=0.05). Conclusions: Increases in street connectivity, residential density, and land-use heterogeneity were associated with walking for transport among middle-age residents of Brisbane, Australia. https://doi.org/10.1289/EHP208

How physicians manage medical uncertainty: A qualitative study and conceptual taxonomy

Background - Medical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described. Objectives - To explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians’ tolerance of medical uncertainty. Design - Qualitative study using individual in-depth interviews. Participants - Convenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1–3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine–pediatrics), at a single large US teaching hospital. Measurements - Semistructured interviews explored participants’ strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies. Results - Participants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness. Conclusions - Physicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work