Sex counseling and the penile prosthesis

Surgical implantation of the penile prosthesis raises critical issues for the assessment and treatment of psychogenic and organically based erectile dysfunction. The importance of treating sexual problems within the overall context of an individual's personal and interpersonal experience is discussed and illustrated with case studies. A regimen of sex counseling is suggested 1) to aid in the differential diagnosis of a psychological from an organic basis for the dysfunction—thereby being likely to correct the problem in the former instance; 2) to provide an opportunity for the client and his partner to explore other satisfying forms of sexual expression and communication; and 3) to increase the probability of successful adaptation if a prosthesis is requested by the client.     

Follow-up of patients and partners experiencing penile prosthesis malfunction and corrective surgery

An interview study is reported involving 14 men who had experienced at least one penile prosthesis malfunction and corrective surgery. Six partners were interviewed separately. The results indicated a broad range of coping patterns in terms of fears and disappointments, but an overall outcome of six cases very satisfactory, five satisfactory despite various worries or complaints, and three unsatisfactory. The discussion emphasizes coping, doctor-patient communication, and difficulties in predicting long-term outcome in these cases.     

Sex therapy and the penile prosthesis: a synthesis

Although the availability of the penile prosthesis has changed the evaluation and treatment of erectile dysfunction, urologists and sex therapists have not combined their skills to develop comprehensive treatment plans. This paper describes one effort to use sex therapy techniques in evaluating and treating candidates for a penile prosthesis. The preoperative assessment focuses on multiaxial diagnosis of sexual problems in patient and partner and on the effects a prosthesis might have on their sexual and marital relationship. Men at high risk for a negative psychological reaction after surgery are offered presurgical sex therapy. Routine follow-up visits are scheduled for all patients during postoperative recovery and at 2-3 months postsurgery. If sexual dysfunction or dissatisfaction persists, sex therapy is again recommended. A case history exemplifies our methods, and the issue of financial costs of counseling vs. predicted benefits in terms of patient satisfaction is discussed.     

Dementia: the importance of psychosocial interventions

The number of people suffering from dementia in The Netherlands is expected to rise from 175,000 in 2006 to 400,000 by the year 2050. Stella Braam recently wrote a book in which she described the experiences of her father, a former psychologist with the attitudes and knowledge of professionals concerning communication and coping with dementia, when he became dement himself. She reports that hardly anyone actually listened to the emotions and wishes of her father. Coping with dementia constitutes a major challenge to society. A working-group of the Dutch Institute for Healthcare Improvement CBO recently advised psychological approaches as the first-line treatment for the neuropsychiatric symptoms of dementia; however, they decided not to give concrete guidelines because of the lack of evidence. A study of the literature reveals that the effects of psychosocial interventions are certainly promising even though the evidence is weak. Investment in more research in this field and immediate implementation of the existing knowledge by caregivers and professional workers are recommended.     

Success and failure: a case study of two rural telemedicine projects

We studied two rural telemedicine projects in the state of Michigan: one that enjoyed success and steady growth in activity, and one that experienced frustration and a lack of clinical utilization. Multiple data collection strategies were employed during study periods, which lasted approximately one year. Both projects enjoyed a grassroots approach and had dedicated project coordinators. However, the more successful project benefited from resources and expertise not available to the less successful project. In addition, the more successful project possessed a more formalized organizational structure for the telemedicine application. A comparison of the two projects leads to a simple conclusion. Telemedicine programmes are positioned within larger health organizations and do not operate in a vacuum. It is crucial that the organization in which it is intended to launch telemedicine is examined carefully first. Each organization operates within a larger environment, which is often constrained by fiscal, geographical and personnel factors. All these will affect the introduction of telemedicine.     

Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors.

The independent contributions to recovery from hip fracture of psychosocial factors including depression, personality, social connectedness, and self-rated health were studied in 219 women age 59 and older (mean age 78.5) who were community dwelling prior to fracture. Initial assessments were conducted shortly after surgery and follow up assessments 2, 6, and 12 months later. By 12 months, 15 patients had died and 15 had entered a nursing home. Substantial declines in physical functioning though not psychosocial status were observed. Only 21 per cent (compared to 81 per cent prefracture) reported walking independently; fewer than 30 per cent had regained reported prefracture levels of physical function. The proportion with elevated depression scores at 12 months was 20 per cent, down from 51 per cent following surgery; 64 per cent rated their health excellent or good at 12 months, up from 43 per cent after surgery. Poor cognitive status and post-surgical self-rated health were predictive of mortality. Among survivors, age, prefracture physical functioning, and cognitive status were associated with recovery in physical function but not psychosocial status. High post-surgery depression scores, but not the other psychosocial factors, were associated with poorer recovery in both functional and psychosocial status. These findings demonstrate the importance of depressive symptoms as one determinant of recovery from hip fracture and support the need to attend to the affective status of hip fracture patients following surgery.     

The Small-Carrion penile prosthesis: Surgical implant for the management of impotence

The normal state of erection can be achieved by bilateral, intracorporal implantation of the Small-Carrion prosthesis. This prosthesis is made of a medical-grade silicone shell with a silicone sponge interior and gives adequate length and normal width to the penis. The prosthesis is firm; however, it is flexible enough to keep the phallus inconspicuous under the proper type of undershorts, either in the normal position or against the abdominal wall. The fact that the patient will have a permanent erection, which is flexible, has not deterred potential candidates from having the surgery.As of December 1977, 260 patients have undergone insertion of the Small-Carrion penile prosthesis with minimal complications. These cases will be discussed.     

Experiences of patients with the semi-rigid Jonas penile prosthesis

A questionnaire was used to investigate the results of the implant of a semirigid Jonas penile prosthesis in 75 men, operated at the department of Urology of the University Hospital Leiden. The results of 31 patients were available for analysis. Sexual intercourse was possible for 77% of patients. The length of the penis was satisfactory in 52%, the rigidity of the penis in 77%. In half the patients, the frequency and the quality of the intercourse was comparable with the period before the erectile dysfunction, in the other half of the cases, both positive and negative changes were mentioned. Orgasm was possible for 3/4 of patients. The overall satisfaction was 74%, in the partner group 65%. Of the patients 87% did not regret the operation. Several patients mentioned that the implant of the prosthesis did reinforce their self-confidence.     

Psychosocial follow-up of penile prosthesis implant patients and partners

One to four years after penile prosthesis surgery, detailed medical and psychosocial interviews were conducted separately with 52 patients and 22 of their partners. Patients tended to be negative or disappointed about postoperative pain, penis size, postoperative sexual frequency, and prosthesis malfunctions. Positive comments emphasized the psychological benefits of renewed masculine self-esteem, repair of humiliation, and reduction of marital guilt. Most patients said they would have the surgery again. Partners corroborated patients' assessments of psychological benefits, but tended to rate the mechanical benefits of the prosthesis somewhat lower. Methodological difficulties in measuring satisfaction with the prosthesis and suggestions for future follow-up research are emphasized in the discussion.     

Relative importance and interrelations between psychosocial factors and individualized quality of life of hemodialysis patients

Since quality of life (QOL) of hemodialysis (HD) patients is low and frequently difficult to improve by medical therapy, it is important to identify psychosocial correlates and life-domains important for HD patients' QOL. Our hypothesis was that psychosocial factors reflecting appraisal, external and internal resources/impediments correlate with QOL and compensate for adverse effects of disease-related variables on QOL. Forty-eight chronic HD-patients identified and rank-ordered life-domains important for QOL and rated their level of satisfaction with those domains. This was performed using a slightly modified version of the Self-Evaluated Individualized QOL (SEiQOL) Scale. Psychosocial factors included perceived-control (PC), social-support and hostility. Demographic and disease-related factors included age, gender, cardiovascular disease (CVD), diabetes, hematocrit, albumin and C-reactive protein. QOL was significantly correlated with PC (r = 0.65) and social-support (r = 0.38), and inversely correlated with hostility (r = –0.31), diabetes and hypoalbuminemia (all at least p < 0.05). PC mediated effects of certain variables (e.g., albumin, gender, hostility) and moderated effects of little social-support and hypoalbuminemia on QOL. Patients' most important QOL domains were health, with which satisfaction was lowest, followed by family, with which satisfaction was highest. Pending replication with larger samples, assessment and enhancement of PC may improve HD patients' QOL.     

工作场所中社会心理因素的测量--两种职业紧张检测模式的应用

目的　对工作要求 -自主模式和付出 -回报失衡模式相应的 2个问卷 (工作内容问卷和付出 -回报失衡问卷 )的中文译本的信度和效度进行测评。方法　以 92 8名医护人员为研究对象 ,运用相关分析、因子分析和Logistic回归分析评价 2个问卷 6个模块 (“工作要求”、“自主程度”、“社会支持”、“外在付出”、“回报”、“内在投入”)的同质信度、结构效度和效标关联效度。结果　 2个问卷 6个模块的Cronbach’sα系数在可接受的范围内 (0 .5 6～ 0 .82 ) ,说明同质信度较好 ;因子分析显示 ,2个问卷的结构效度与理论模式基本吻合 ,但“工作要求”与“内在投入”2个模块需要进一步修订 ;并且 2个问卷均表明职业紧张与抑郁症状具有明显的相关性 (OR :1.6 3～ 2 .6 4 ,P <0 .0 1) ,提示良好的效标关联效度。结论　工作要求 -自主模式和付出 -回报失衡模式及其相应问卷能够较好地应用于中国 ,评价社会心理因素对职业人群的影响 ,但仍需要进一步的修订。     

Surgical treatment of erectile impotence using the inflatable penile prosthesis

The inflatable penile prosthesis provides a safe and effective means of surgically correcting male erectile impotence. This totally implanted, hydraulically operated device provides a means whereby a nearly normal penile erection can be attained when desired, with a flaccid penis at all other times. At the Mayo Clinic, the device has been implanted in 240 male patients who had erectile impotence. Patient selection depends on findings on a complete history, physical examination, routine laboratory studies, psychologic testing employing MMPI, and psychologic evaluation and consultation. Patient with either organic or psychogenic impotence are suitable candidates for penile implantation, the selection being based on specific criteria. The overall success rate with this prosthetic device has been 95%. Infection is the major pathologic complication, occurring in 3.7% and requiring removal of the device. Mechanical complications occur in approximately 5.5% of patients. All mechanical complications are correctable, but they usually require secondary surgical procedures. This experience indicates that the inflatable penile prosthesis is an excellent means of correcting male erectile impotence and reliably achieves the patient's preoperative expectations.This paper has been copyright 1978 by the Mayo Foundation.     

Success and failure in the measurement of restraint: notes and data

OBJECTIVE: The clarification of the present confusion about the confounding of success and failure in the measurement of restrained eating. METHOD: Close inspection of results regarding the Restraint Scale (RS) and the restraint scales of homogeneous measures of restrained eating, for example, the restraint scales of the Three-Factor Eating Questionnaire (TFEQ) and the Dutch Eating Behaviour Questionnaire (DEBQ). RESULTS: Various studies have led to the distinction of two different types of confounding of success and failure in the measurement of restrained eating. The first confounding is associated with the RS and the inability of its scores to differentiate between inhibition and disinhibition of restraint in one person, as a result of variance across time within one person in food intake and binging. The second type of confounding applies to the homogeneous measures of restrained eating, for example, the restraint scales of the TFEQ and DEBQ. Here the confounding is associated with the inability of their restraint scores to differentiate between dieters with low versus high susceptibility toward failure of restraint, as a result of variance across persons in food intake and binging. DISCUSSION: In contrast to the first confounding, the confounding of successful and unsuccessful dieters in subjects with high restraint scores can be easily unconfounded, by using a two-factorial classification including both scores on "pure" measures of restraint and scales for tendency toward overeating. For future research, the distinction between successful and unsuccessful dieters is an important first step in clarifying why some dieters do overeat under certain conditions.     

Adjustment following surgical implantation of a penile prosthesis: a critical overview

The literature on postsurgical adjustment and/or satisfaction of patients and/or their partners following implantation of a penile prosthesis is reviewed. Only those studies that have systematically assessed psychological variables independent of surgical or functional outcome are included. It is reported that while transitory emotional problems were not uncommon, 64-100% of the implant recipients reported being at least fairly satisfied. Similar levels of satisfaction were reported for their partners when they were interviewed together or when patients responded for their partners. However, lower levels were reported when partners were interviewed separately. Satisfaction was reported to be associated with several variables, and high-risk populations were identified. It is important to interpret these conclusions with extreme caution because of the many serious methodological weaknesses contained in these studies. These methodological problems in the literature are reviewed, and recommendations for future research are presented.     

Risk factors for endemic giardiasis: highlighting the possible association of contaminated water and food

This study was conducted to reassess the risk factors for giardiasis in communities of the Orang Asli (indigenous people) in Pahang, Malaysia. Stool samples were collected from 321 individuals (2-76 years old; 160 males, 161 females). Data were collected via laboratory analysis of faecal samples and a pre-tested standard questionnaire. River water samples were tested for Giardia cysts and Cryptosporidium oocysts. The overall prevalence of G. intestinalis infection was 23.7%. Children < or =12 years old had the highest infection rate and have been identified as a high risk group (odds ratio (OR)=6.2, 95% CI 1.5-27.0, P<0.005). The risk of getting giardiasis also appeared to be significantly associated with drinking piped water (OR=5.1, 95% CI 0.06-0.7, P<0.005) and eating raw vegetables (OR=2.4, 95% CI 0.2-0.6, P<0.005). In conclusion, sociodemographic factors have always been associated with the high prevalence of Giardia infections in Malaysia. However, the present study also highlights the need to look into the possibility of other risks such as water and food transmission routes. In future, it is necessary that these two aspects be considered in control strategies.     

Permanence and change: psychosocial factors in the outcome of adolescent pregnancy

Past work suggests that stressful life changes and the availability of social support exert opposing effects on the health of adolescent mothers and their infants. We have developed a theoretical perspective in which the effects of both stressful and protective social factors are viewed as acting on health through their capacity to either undermine or sustain an individual's sense of permanence and continuity in life experience. To examine this hypothesis, a population of 89 unmarried, pregnant adolescents were studied to ascertain psychosocial influences on maternal and infant health outcomes. This paper reports a cross-sectional analysis of perinatal complications and psychological well-being as they relate to a variety of psychosocial variables, including stressful life events, social network support and a questionnaire measure of the sense of permanence. Multivariate analyses indicate that while life events and social support had effects in the expected directions, the sense of permanence constituted an important, additional factor in the effects of social experience on pregnancy outcomes.     

Success and failure in Web-based medical collaboration

A Web-based collaboration tool was developed for ophthalmologists, called ?yenet. A feasibility study was performed in 2000. The system was ready to use in 2001, but the usage of the system was disappointing, compared to the enthusiasm expressed in the feasibility study. In order to identify facilitators and barriers for usage of the system, we performed a qualitative study. Nineteen ophthalmologists from different parts of Norway, who had been using the system but to a varying degree, were interviewed. The study revealed that a single common solution is not appropriate for the ophthalmology community as a whole. It also revealed that colleagues from abroad should be allowed to use the system, in order for it to act as a tool for collaboration and seeking advice in complex medical problem solving.