Perceptions on sexual activity after total knee and total hip arthroplasty:A mixed method study of patients, partners, and surgeons

BackgroundIn-depth insight into couples’ experiences of sexual activity before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is lacking. The aim of this study was to explore patients’ and partners’ experiences, complemented by surgeons’ opinions on safe resumption of sexual activity after surgery.MethodsMixed method study: 1) Semi-structured interviews among sexually active couples, 1.5 years postoperatively and 2) A survey among surgeons about recommendations of sexual activity after THA/TKA.ResultsOf the 150 invited couples, 90 (60%) responded (THA: n=39; TKA: n=42). Five couples participated (THA: n=3; TKA: n=2), while 85 (94%) couples refused participation. Two themes emerged: “Couples physically and mentally adjusted to the new situation” and “Couples undoubtedly trusted the surgeon as the provider of information.” In total, 27% (47/175) of THA surgeons participated. Fifty percent agreed with the recommended sexual positions researched by Charbonnier et al. Opinions differed widely regarding when to safely resume sexual activity. Of the TKA surgeons, 36% (76/211) responded. Almost all surgeons (95%) agreed that there were no restrictions. However, some discomfort was expected when patients bend the knee or kneel during sex. Half of the surgeons indicated that providing information about sex was necessary.ConclusionsAll couples physically and mentally adapted to the new situation without considering safety measures. Patients trusted surgeons in providing safety information. Surgeons should inform patients succinct and explicitly, especially since surgeons’ recommendations showed great variability. More motion research on hip and knee may add to uniform guidelines

Let's talk about sex:Exploring factors influencing the discussion of sexual health among chronically Ill patients in general practice

Background Chronic diseases are often associated with sexual dysfunction (SD). Little is known about the practice patterns of general practitioners (GPs) regarding sexual care for chronically ill patients. Therefore, the aim of this study was to examine; to what extent GPs discuss SD with chronically ill patients; the barriers that may stop them; and the factors associated with discussing SD. Methods A cross-sectional survey using a 58-item questionnaire was sent to 604 Dutch GPs. Descriptive statistics and associations were used for analysis of the data. Results Nearly 58% (n = 350) of all GPs approached gave a response and 204 questionnaires were analysable (33.8%). Almost 60% of respondents considered discussing SD with patients important (58.3%, n = 119). During the first consultation, 67.5% (n = 137) of the GPs reported that they never discussed SD. The most important barrier stopping them was lack of time (51.7%, n = 104). The majority (90.2%, n = 184) stated that the GP was responsible for addressing SD; 70.1% (n = 143) indicated that the GP practice somatic care nurse (GPN) was also responsible. Nearly 80% (n = 161) of respondents were unaware of agreements within the practice on accountability for discussing SD. This group discussed SD less often during first and follow-up consults (p = 0.002 and p < 0.001, respectively). Of the respondents, 61.5% (n = 116) felt that they had received insufficient education in SD and 74.6% (n = 150) stated that the subject is seldom discussed during training. Approximately 62% of the GPs (n = 123) wanted to increase their knowledge, preferably through extra training. According to 53.2% of the GPs (n = 107) it was important to improve the knowledge of the GPN. The most frequently mentioned tool that could help improve the conversation about SD was the availability of information brochures for patients (n = 123, 60.3%). Conclusions This study indicates that Dutch GPs do not discuss SD with chronically ill patients routinely, mainly due to lack of time. An efficient tool is needed to enable GPs to address SD in a time-saving manner. Increased availability of informational materials, agreements on accountability within GP practices, and extra training for the GPs and GPNs could improve the discussion of SD

Spontaneous abortion rate and advanced maternal age: Consequences for prenatal diagnosis

Abstract Maternal age related and procedure-related fetal abortion rates were studied in 384 women aged 36 and over scheduled for transabdominal chorionic villus sampling (TA-CVS) at 12-14 weeks of gestation. The pre-TA-CVS abortion rate within 30 days of intake (at 6-10 weeks of gestation) rose from 1·9% at age 35-36 years to 10·9% at 40 years and older. Women entering in the 6th week of gestation had a greater probability of aborting before TA-CVS than women entering after day 48. 26 women aborted spontaneously before TA-CVS, the majority of abortions occuring at 10-12 weeks. TA-CVS was done in 346 women. 11 pregnancies were terminated because of genetic anomalies, and 8 women had spontaneous fetal loss. These findings justify delaying prenatal diagnosis in older pregnant women until 12 weeks of gestation

Knowledge and attitude of nursing students regarding older adults' sexuality: a cross-sectional study

Background: Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.Objectives: To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults. Design: Cross-sectional.Settings: A University of Applied Sciences in the Netherlands.Participants: Nursing students, >= 16 years who were able to read and write in Dutch.Methods: The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.Results: In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitudescore 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%).Conclusions: Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.Neuro-urology: functional disorders in male and female urogenital trac

Seksuele disfunctie en relatieproblemen na prostaatkankerbehandeling: De gewenste zorg vanuit het oogpunt van patiënt en partner

Erectile dysfunction (ED) is one of the most common side effects of prostate cancer (PC) treatment and may lead to changes in a relationship. The aim of this study was to identify sexual and/or relational problems and to investigate what kind of supportive care is preferred by patients and their partners. A cross-sectional survey was performed among men diagnosed with PC enrolled in active surveillance or treated with laparoscopic radical prostatectomy, brachytherapy, intensity-modulated radiotherapy or hormonal therapy. If possible, partners were included as well. Out of 250 patients, 80,5% suffered from moderate to severe erectile complaints. Half of them (53,7%) was treated for ED and a great part was partially (30,7%) up to not satisfied (25,7%). Out of 168 partners, 50,6% found it difficult to cope with changes around sexuality. The majority of men (74,7%) preferred a standard consultation with a urologist-sexologist three months after treatment to discuss sexuality

Disability in activities of daily living: a multifactorial approach

Activities of daily living (ADL), such as bathing and doing groceries are essential for maintaining independence in the community. Previous longitudinal studies have shown that about 20 to 30% of older persons (70 years and older) experience ADL disability. Older persons who are ADL disabled have higher rates of morbidity and mortality, and have a poorer quality of life. Disability is a dynamic process in which older persons both develop disability and recover from a period of disability. The recovery rate after a first episode of disability seems to be high (81% within 12 months), yet having experienced disability is a good predictor of future disability, thus, intervention in an early stage may still prevent sustained disability. Therefore, it is important to identify risk factors in an early stage of the disabling process, that might be targeted in preventive strategies. An impaired physical ability is an important component of disability that tends to occur early in the disabling process, and is characterized by irreversible changes in the sensory-motor performance of a person. Hence, an impaired physical ability may be a suitable target for preventive strategies. In the present thesis, we investigated whether a decreased level of physical function and presence of subclinical atherosclerosis were risk factors for ADL disability. In addition, the role of multiple domains of functioning on the current and future ADL disability status was studied. Leg strength and lower body strength were associated with both an impaired physical ability and ADL disability. In addition, other measures of physical function (i.e. handgrip strength, gait speed, physical activity and lung function) were either a risk factor for an impaired physical ability or for ADL disability. From these findings, we can conclude that leg strength is an important factor to consider in preventive strategies. Overall, markers of atherosclerosis and their change over time, were associated with lower handgrip strength and higher rate of change in physical ability. We did not find a direct effect between atherosclerosis and rate of change in ADL disability, which indicates that monitoring atherosclerosis is not effective to prevent or delay the onset of ADL disability. These findings may suggest that ADL disability is a more a consequence of experienced clinically manifest vascular events, rather than the effect of progression of atherosclerosis. There is not a single domain that is particularly important in determining current ADL status, but multiple health related domains contribute to current ADL disability. This finding stresses the importance of a multifactorial intervention. Focus on a single domain in preventive strategies could lead to a less effective strategy toward the delay or prevention of ADL disability. Using a multifactorial prediction model, including the number of chronic diseases, muscle strength, age, gender and socioeconomic status, we were able to identify individuals who were at high risk of developing ADL disability over a course of ten years. In the development of preventive strategies, we should focus on a multifactorial approach, long duration of the intervention, inclusion of middle-aged persons, and impaired physical ability as important outcom

Vitaal Twente, Twente als Vitaalste regio in Nederland

Vitaal Twente heeft ten doel via samenwerking initiatieven te ontplooien om daarmee haar missie &lsquo;Twente, de vitaalste regio van Nederland&rsquo; te realiseren alsmede het verrichten van alle andere handelingen, die met het vorenstaande in de ruimste zin verband houden of daartoe bevorderlijk kunnen zijn. Het aan het doel dienstbare vermogen wordt gevormd door subsidies, giften, eventuele bijdragen van partners, legaten, hetgeen door erfstelling wordt verkregen, alsmede andere baten. Vitaal Twente heeft geen winstoogmerk en houdt niet meer vermogen aan dan redelijkerwijs nodig is voor de verwezenlijking van het doel van de stichting. Interview zie:&nbsp; https://youtu.be/eVvd4UQA8K

Treatment-Related Sexual Side Effects From the Perspective of Partners of Men With Prostate Cancer

Development and application of statistical models for medical scientific researc

Effects of self-management support programmes on activities of daily living of older adults: a systematic review.

Background: The ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition. Objective: To gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home. Design: A systematic literature review of original research publications. Data sources: Searches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country. Review methods: Publications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group. Results: A total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomized controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults. Conclusions: There is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults. Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community. (aut. ref.