中国艾滋病单阳家庭感染者阴性配偶或恋人阳转情况的Meta分析

目的了解艾滋病单阳家庭感染者阴性配偶或恋人阳转情况。方法检索中国期刊全文数据库(CNKI)、万方数据资源系统和PubMed,将艾滋病单阳家庭感染者阴性配偶或恋人阳转的文献纳入研究,应用R软件进行Meta分析。结果最终纳入11篇文献,经Meta分析结果显示,中国艾滋病单阳家庭感染者阴性配偶或恋人总阳转率为1.0/100人年;不同经济水平和疫情程度的地区,艾滋病单阳家庭感染者阴性配偶或恋人阳转率均为1.0/100人年。结论中国艾滋病单阳家庭感染者阴性配偶或恋人总阳转率不高。     

Active consideration: conceptualizing patient-provided support for spouse caregivers in the context of prostate cancer

In this study, the authors examine the under-investigated topic of patient-provided support for spouse caregivers. Thirty-four men with prostate cancer and their female partners were interviewed separately three times: before the man's radical prostatectomy, 8 to 10 weeks postsurgery, and 1 year postsurgery. The core category of active consideration encompassed 4 dimensions: easing spousal burden, keeping us up, maintaining connection, and considering spouse. Patient-provided support entails two overlapping tasks: minimizing the practical and emotional impact of the illness and tending to the caregiver's social-emotional needs. A theory expounding on the double bind of being both a patient and an agent in light of masculine socialization practices is articulated and brought to bear on the phenomenon of patient-provided support.     

Affect and enacted support in couples undergoing in-vitro fertilization: when providing is better than receiving

Although the term social support has positive connotations, research has shown that receiving help may be a double-edged sword. Received support may have no effects or may even be detrimental to recipients' well-being. However, providing support may have beneficial effects for the helper. This paper reports a study of competing and interactive effects of enacted support on affect in couples undergoing assisted reproduction treatments. Sixty-six male/female couples from two German fertility clinics participated in this study. Affect and support were assessed at 3 time points: upon oocyte and sperm collection, after embryo transfer, and following the first pregnancy test (3 weeks after the treatment outcomes were known). Results indicated that depending on the providers' gender, different forms of support provision predicted better affect developments. While women seemed to benefit from providing emotional support, higher positive affect among men was related to their provision of instrumental support. Neither support receipt nor reciprocal support, however, were reliably associated with affect changes. Results partially coincide with predictions from esteem-enhancement theory of supportive exchanges.     

‘They’re doing surgery on two people’: a meta‐ethnography of the influences on couples’ treatment decision making for prostate cancer

Background Current orthodoxy suggests that patients need to be provided with full information about their care and that treatment options should be discussed with patients and family members. This imperative is especially challenging when there is a lack of consensus about treatment effectiveness and equivocacy over different types of interventions. In the case of prostate cancer, evidence is contested as to the efficacy of different treatments. Thus, involving patients and their family members in treatment choices is complex and little is known about how patients and their partners process these decisions when there is uncertainty about different outcomes. This paper has reviewed the literature on the way couples approach such decision making in relation to treatment for prostate cancer. Objective A meta‐ethnographic synthesis of published qualitative papers that focused on the influences on patients’, and their partners’ treatment decision making for prostate cancer, was conducted in order to identify and understand barriers and facilitators which impact on this process. Results Our synthesis indicates that the couples’ relationship ‘dynamic’ provides a contextual background against which treatment decisions are negotiated and made. Discussion and conclusions We propose that the findings from this synthesis can enhance the potential for shared decision making for patients, and their partners, when facing a treatment decision for prostate cancer. By understanding the couples’ relationship dynamic pre‐diagnosis, clinicians may be able to tailor the communication and information provision to both patients and their partners, providing a personalized approach to treatment decision making.     

‘I told her this is your life’: relationship dynamics,partner support and adherence to antiretroviral therapy among South African couples

Abstract

Despite the important role of social relationships for health and wellbeing, little is known about how primary partners affect adherence to HIV care and treatment. We qualitatively explored how relationship dynamics and partner support influence adherence among couples from KwaZulu-Natal, South Africa. Twenty-four heterosexual couples with at least one HIV-positive partner completed semi-structured interviews on topics including relationship dynamics (intimacy or emotional closeness, communication, violence), experiences with HIV care and treatment and HIV-related social support. The majority of couples were seroconcordant HIV-positive (92%) and both on antiretroviral therapy (ART) (63%). Participants described how primary partners both interfered with and supported adherence. Negative forms of influence included relationship conflict, which resulted in forgetfulness to take pills, and men’s attempt to control use of ART. However, participants were more likely to highlight positive forms of influence on adherence, which included social support (instrumental, informational and emotional), intimacy and commitment. The findings also suggest a reciprocal relationship between ART and relationships such that couple ART use may enhance relationship quality. Primary partners are important pillars of support for ART adherence, especially in contexts of high unemployment and poverty. Future interventions that encourage and leverage these supportive relationships could improve ART adherence among heterosexual couples in similar settings.     

Gender relations, prostate cancer and diet: re-inscribing hetero-normative food practices

Although diet might be a valuable adjunct to prostate cancer care, men typically have poorer diets than women and are less likely to change the way they eat after a cancer diagnosis. Gender theory suggests that dominant ideals of masculinity shape men's health and food practices; however, the role of female partners in men's diets is poorly understood. Through qualitative analysis of in-depth interviews, this article explores accounts of 14 Canadian couples' food practices guided by a gender relations framework to expose how tacit performances of masculinity and femininity interact to shape the diets of men with prostate cancer. Findings show that many men became more interested and involved in their diets after a prostate cancer diagnosis, practices that might be theorized as a counter hegemonic project or 'feminization', adding to other prostate cancer induced emasculations (i.e., treatment induced incontinence and impotence). At the same time, however, couples mutually limited men's engagement with diet while concurrently reinforcing women's traditional femininities in nurturing the men in their lives through food provision. Also embedded here were women's attempts to mitigate subordinate productions of masculinity by catering to their partner's tastes as well as monitoring their diets. Most couples mutually maintained traditional gender food 'roles' by positioning women as proficient leaders in domestic food provision and men as unskilled 'try-hard' and sometimes uninterested assistants. Findings also revealed complex gender power dynamics that predominated as complicit in sustaining hegemonic masculinity through women's deference to men's preferences and careful negotiation of instrumental support for men's diet changes. Overall men and women jointly worked to re-inscribe hetero-normative family food practices that shaped men's diets and nutritional health.     

InVance球部悬吊术治疗前列腺癌根治术后压力性尿失禁

目的评价InVance球部悬吊术治疗前列腺癌根治术后压力性尿失禁的临床效果。方法回顾性分析2005年3月至2011年3月采用InVance球部悬吊术治疗6例前列腺癌根治术后压力性尿失禁患者的临床资料。结果6例手术时间80～120min,出血量20～50ml。术后2d拔除气囊导尿管,切口均Ⅰ期愈合。随访12～29个月,4例治愈,1例改善,1例无效。2例出现暂时性尿潴留,1例出现短期内会阴疼痛。6个月后最大尿流率（15．9±7．7）ml／s,残余尿量0-20ml／s。结论InVance球部悬吊术简单、创伤小、手术并发症少,对前列腺癌根治术后压力性尿失禁有较好疗效。     

Received social support for sexually transmitted disease-related care-seeking among adolescents.

OBJECTIVE: To describe the types and sources of social support received by adolescents obtaining care at a large urban sexually transmitted diseases (STD) clinic. METHOD: A total of 140 females and 82 males (ages 13-20 mean, 17.6 years) indicated whether they had received any of 11 types of social support, and, if so, from whom. Types of support included: companionship to clinic, advice on symptom interpretation, advice to seek clinical care, advice on potential sources of care, help making appointments, prior provision of medications, supportive talking, help talking to sex partner, provision of money, provision of transportation, and help getting STD protection. RESULTS: Eighty percent received at least one type of social support of whom 77% of subjects reported at least two types of support. The most frequently received support was information about symptom interpretation and appropriate clinic use (47% for each); 41% were accompanied to their clinic visit, and 37% received emotional support. A total of 15% of men but only 4% of women (p < .05 by Chi-square) received medication (usually antibiotics) but women were more likely to receive financial help (5% vs. 0% for women and men, respectively; p < .05). Although women obtained support earlier in the care-seeking process than men, there were no other significant gender differences in types of received support. Friends and sex partners were the most frequently cited sources of companionship and transportation, but parents provided transportation, information, medicine, and money for 15-20% of subjects receiving these types of support. CONCLUSION: Most adolescents receive a social support as part of seeking care for STD-related problems.     

Complexities of Informal Social Support Arrangements for Black Lesbian Couples

This qualitative study examined how Black lesbian couples receive informal social support from their social networks. Guided by an integrated framework of symbolic interactionism and Black feminist theory, interviews were conducted with 11 Black lesbian couples (22 individuals) in committed relationships. Using grounded theory methodology, it was found that Black lesbian couples received informal social support from different sources, but that this support was provided to individuals as a means of sustaining individuals' roles as daughters and mothers. Although extended families actively fulfilled perceived family obligations, they negated the existence of lesbian individuals' sexual identity, intimate relationships, and families built with lesbian partners. Friends, church communities, and gay and lesbian communities did not validate Black lesbian couplehood or families headed by Black lesbian couples, but served as supportive sites for individuals. Black lesbian couples responded to social invisibility by engaging in self‐validating processes and limiting access to their families.     

Formal support of stroke survivors and their informal carers in the community: a cohort study

This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarason's social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.     

Quality of life in partners of patients with localised prostate cancer

Purpose

The diagnosis of prostate cancer and the following treatment does not only affect the patient, but also his partner. Partners often suffer even more severely from psychological distress than the patients themselves. This analysis aims to describe the quality of life (QoL) after the cancer diagnosis over time and to identify the effects of possible predictors of partners’ quality of life in a German study population.

Data and methods

Patients with localised prostate cancer and their partners were recruited from a prospective multicenter study in Germany, the Prostate Cancer, Sexuality, and Partnership (ProCaSP) Study. At five observation times during the follow-up period of 2 years after diagnosis, QoL (EORTC QLQ-C30) and personal, social, and cancer-related health factors as well as adaptation and coping factors of 293 couples were observed and analysed with mixed effects analysis.

Results

The men’s prostate cancer diagnosis had a small, but significant impact on their partner’s QoL. However, QoL of partners was most affected by the partners’ own physical health and psychological condition, time, and their relationship quality.

Conclusion

The finding that average QoL increased again 3 months after diagnosis and later should give partners faith and hope for the future. The identified most important predictors of partners’ QoL are potentially susceptible to intervention, and further research on target groups in special need of support and on adequate interventions is needed.     

The impact of enteral feeding protocols on nutritional support in critically ill children

Background:  Studies have shown that feeding protocols may assist in achieving optimal nutritional care in critically ill children. The present study aimed to assess the impact of enteral feeding protocols on nutritional support practices through a continuous auditing process over a defined period.
Materials and methods:  A prospective audit on nutritional practice was initiated in 1994–1995 on all ventilated patients who were admitted for more than a complete 24-h period in the paediatric intensive care unit. The audit was repeated 1997–1998, 2001 and 2005. The collection of data on outcomes included the time taken to initiate nutritional support, the proportion of patients fed via the enteral versus parenteral route, and the proportion of children reaching 50% and 70% of the estimated average requirement (EAR) by day 3. Feeding algorithms and protocols were introduced after each audit with a view to improving practices.
Results:  Over the study period, time taken to initiate nutrition support was reduced from 15 h (1994–1995), 8 h (1997–1998), 5.5 h (2001) to 4.5 h (2005). The proportion of patients on parenteral feeds was reduced from 11% (1994–1995) to 4% (2005). An increase was also documented in the percentage of patients receiving a daily energy provision of 50% and 70% of the EAR by day 3 after the initiation of nutritional support (6% in 1994–1995 to 21% in 2005 for 70% of EAR).
Conclusion:  The present study demonstrates that feeding protocols improve nutritional practices in a paediatric intensive care unit. However, protocol introduction needs to be monitored regularly through audit.     

Patient Characteristics Impacting Health State Index Scores, Measured by the EQ-5D of Females with Stress Urinary Incontinence Symptoms

Objective:  To describe the characteristics of women seeking treatment for symptoms of stress urinary incontinence (SUI) and to investigate the association of SUI symptoms with generic health-related quality of life (HRQoL) as measured by the EuroQol (EQ-5D) instrument.
Methods:  The Stress Urinary Incontinence Treatment (SUIT) study was a 12-month observational study in four European countries that evaluated the cost-effectiveness of duloxetine compared with other forms of nonsurgical intervention in the treatment of the symptoms of SUI. Four hundred thirty-one physicians observed women seeking treatment for their SUI, and recorded the care provided and the outcomes of that care at enrollment and at 3, 6 and 12 months afterward The impact of SUI on baseline HRQoL as expressed by the EQ-5D index score was assessed by linear and logistic regression.
Results:  Three thousand seven hundred sixty-two women were enrolled into SUIT, with the largest patient group from Germany. Overall, the majority of women were postmenopausal, had a mean age of 58.0 years, were not current smokers, and tended to be overweight (mean body mass index [BMI] = 27.7 kg/m²), with at least one comorbidity. The health state index scores were significantly and independently influenced by the presence of comorbidity(ies) affecting quality of life, total number of stress and urge incontinence episodes, urinary incontinence subtype, comorbidity(ies) affecting incontinence, BMI, socioeconomic status, educational status, age, and country.
Conclusion:  This article describes the characteristics of patients at the SUIT enrollment visit, and demonstrates that the number of incontinence episodes has a significant impact on the EQ-5D index score.     

PRISM (Program of Resources,Information and Support for Mothers) Protocol for a community-randomised trial [ISRCTN03464021]

Background  

In the year after birth one in six women has a depressive illness, and 30% are still depressed, or depressed again, when their child is 2 years old, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support overall, more negative life events, and poorer physical health. Their perceptions of factors contributing to depression are lack of support, isolation, exhaustion and physical health problems. Fewer than one in three affected women seek help in primary care despite frequent contacts.     

Professional Identity and Coping Behaviors in Dual‐Career couples

Abstract: This qualitative study of 15 dual‐career couples examines the connection between partners’ professional identity and coping behaviors implemented in response to work and family stressors. The analysis provided evidence that dual‐career couples enact professional and family identities that rely on being competent and responsible in both work and family roles. Coping patterns fell into similar patterns across work and family domains, but strategy use was unique by domain and reflective of couples’ belief in the value of interdependent interactions.     

The utility of volunteer home-visiting support to prevent maternal depression in the first year of life

Background   Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary.
Methods   A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual – Third Edition – Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support.
Results   Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months.
Conclusions   It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.     

Women's voices after pregnancy loss: couples' patterns of communication and support.

This paper reports results of a study of prenatal diagnosis patients who lost pregnancies. The women felt they shared much in common with their male partners and generally felt understood and supported by the men. However, many of the women also saw their responses to the loss as different from those of their male partners. A variety of coping patterns were adopted by the women in the face of these differences. Implications are considered for preventive efforts to minimize distress; treatment approaches to help couples who experience greater difficulties; and future research directions.     

Public-sector ART in the Free State Province,South Africa: Community support as an important determinant of outcome

The treatment outcomes for large-scale public antiretroviral therapy (ART) programs in developing countries, although promising, are still preliminary. The scaling-up of ART in resource-limited settings is inevitably hampered by human resource shortages. Therefore, community support for ART patients may play an important role in achieving favorable treatment outcomes. This study aimed to extend the current literature by investigating how immunological and virological responses to ART, measured at three points in time (after six, 12, and 24 months of ART), are influenced by patient characteristics (age, sex), health literacy (educational level and knowledge about HIV/AIDS), baseline CD4 cell count, baseline viral load, and three forms of community support (treatment buddy, community health worker [CHW], and HIV/AIDS support group). Cross-lagged regression analysis was used to test these relationships in a sample of 268 patients enrolled in the public-sector ART program of the Free State Province of South Africa (2004–2007). After 24 months of ART, 76.4% of patients were classified as treatment successes (viral load < 400 copies/mL, CD4 ≥ 200 cells/μL), compared with 64.1% at 12 months and 46.1% at six months. When we examined the predictors of ART success, baseline health and all three community support initiatives had a positive effect on ART outcomes after six months, whereas patient characteristics had little effect. Six months later, patients with the support of a treatment buddy, CHW, or support group had better ART outcomes, whereas the impact of baseline health had diminished. After two years of treatment, community support again emerged as the most important predictor of treatment success. This study confirms that the ART provided by South African public-sector health services is effective. These results provide evidence from the field that communities can be mobilized to sustain these favorable outcomes under conditions of limited human resources for healthcare.     

‘I’m waiting for that’: Interest in the use of PrEP for safer conception in Botswana

ABSTRACT

Safe and effective low-cost safer conception (SC) methods are increasingly available and being integrated into national guidelines in sub-Saharan African contexts. Sero-different couples of childbearing age can benefit from such services and the routine provision of SC counselling. Pre-exposure prophylaxis (PrEP) to prevent HIV acquisition to uninfected partners can reduce the chances of HIV transmission when trying to achieve pregnancy. Botswana has a strong commitment to reducing new HIV infections but PrEP is not yet widely available and little guidance has been offered on counselling sero-different couples. We conducted qualitative in-depth interviews in Gaborone, Botswana with 10 HIV healthcare providers and 10 women living with HIV of childbearing age because they act as a key conduit for reaching sero-different partners with information about PrEP. We examined knowledge and attitudes towards PrEP to assess the viability and develop a deeper understanding of this SC option. Interviews were analysed using an interpretive phenomenological approach. Three themes emerged: (1) awareness of PrEP is limited, (2) providers and women overwhelmingly showed interest in PrEP and (3) women living with HIV and providers have concerns about PrEP use. With the correct support, PrEP could be a useful SC option for sero-different couples in Botswana and other sub-Saharan contexts.     

A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship

Background

The shared impact of breast cancer for women and their male partners is emerging as an important consideration during the experience of a breast cancer diagnosis, particularly during survivorship. This study aimed to explore the experiences of women and their partners during early survivorship and contributes a range of insights into the lives of those intimately affected by breast cancer.

Methods

In-depth interviews were completed with Australian women survivors of breast cancer (n?=?8) and their partners (n?=?8), between six months and five years following cessation of treatment. Questions included a focus on the women and their partners’ daily experiences during early survivorship, including the management of ongoing symptoms, engagement in leisure and social interests, returning to work, communicating with each other, maintenance of the current relationship and other important roles and responsibilities. Thematic analysis was employed to determine key themes arising from the dyadic accounts of women and their partners’ experiences during early breast cancer survivorship.

Results

Women and their partners experienced many changes to their previous roles, responsibilities and relationships during early breast cancer survivorship. Couples also reported a range of communication, intimacy and sexuality concerns which greatly impacted their interactions with each other, adding further demands on the relationship. Three significant themes were determined: (1) a disconnection within the relationship - this was expressed as the woman survivor of breast cancer needing to prioritise her own needs, sometimes at the expense of her partner and the relationship; (2) reformulating the relationship - this reflects the strategies used by couples to negotiate changes within the relationship; and (3) support is needed to negotiate the future of the relationship - couples emphasised the need for additional support and resources to assist them in maintaining their relationship during early survivorship.

Conclusion

It can be concluded that the early survivorship period represents a crucial time for both women and their partners and there are currently limited options available to meet their shared needs and preferences for support. Findings indicate that a suitable model of care underpinned by a biopsychosocial framework, access to comprehensive assessment, timely support and the provision of targeted resources are urgently needed to assist women and their partners during this critical time.