The experience of partner relationships for male survivors of childhood sexual abuse: a qualitative synthesis

Research has documented wide-ranging psychological impacts of childhood sexual abuse (CSA) for male survivors, but their experience of relationships is understudied. This qualitative review aimed to synthesize the qualitative literature concerning the experience of partner relationships for male CSA survivors. Electronic searches were conducted across PsycINFO, CINAHL, and PubMed, complemented by hand searches of references. Searches were limited to English-language peer-reviewed studies. Studies were included if they sampled adult male CSA survivors and reported qualitative data on their experience of partner relationships. Sixteen studies met the review criteria. Articles were quality-appraised using the Critical Appraisal Skills Programme qualitative checklist (2018), and narrative synthesis derived five themes: “sexual orientation confusion,” “sexual intimacy difficulties,” “the barrier of emotional intimacy,” “navigating agency,” and “healing and growth through love.” Key findings were male CSA survivors can face considerable barriers to relational intimacy; however, romantic relationships also offer a space to heal and experience post-traumatic growth (PTG). Clinicians should be aware of the diffuse impacts CSA can have upon male survivors’ intimate relationships. Helping survivors and their partners build a safe space in which to process CSA, reassert agency and relational boundaries, and express love and validation can support survivors toward PTG

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo