Experiencing vaginismus–sufferers beliefs about causes and effects

The present study examined the experience of vaginismus in 89 sufferers and ex-sufferers using quantitative and qualitative methodologies. The results provide insights into the effects of vaginismus on the sufferers' self perception and on their relationships with important others. It is suggested that vaginismus should not be regarded as a psychosexual problem but as a psychosocial experience in which defences have been created to protect the self, and that the vaginal spasm is only one of the many effects of this defence.     

All in the Family: Help-Seeking by Significant Others of Problem Gamblers

Problem gambling can significantly affect the lives of concerned significant others (CSOs) of problem gamblers, especially family members, but little is known about their help-seeking activities and experiences. This paper explores help-seeking by CSOs of problem gamblers and their related motivators and barriers. A telephone interview was administered to 48 CSOs who called an Australian gambling helpline seeking assistance for themselves and/or a person with gambling problems. Key motivators for seeking help (through helplines, non-professional sources, and self-help measures) were concerns the gambling might become a major problem, negative emotions, problems maintaining normal daily activities, concerns for dependents’ welfare, and health concerns. Barriers included wanting to solve the problem on their own, and shame. Findings highlight the need to better equip CSOs to assist both the person with gambling problems towards treatment and recovery and to protect their own physical, emotional, social and financial wellbeing.     

Breastfeeding Aversion Response (BAR): A Descriptive Study

Introduction

For many women, breastfeeding their infant is an enjoyable experience. Some, however, have reported negative sensations such as an overwhelming need to unlatch while breastfeeding. This phenomenon is known as breastfeeding aversion response (BAR). The incidence of BAR is unknown and literature on this experience is limited. This study therefore aimed to expand the understanding of BAR using an online survey targeting those who have experienced feelings of aversion while breastfeeding.

Methods

An online survey was distributed within Australia using purposive sampling to those who self-identified as experiencing BAR. This survey contained 5 sections: (1) demographics and health-related characteristics, (2) breastfeeding difficulties and onset of BAR, (3) the experience of BAR, (4) birth and breastfeeding experience, and (5) coping with BAR and support. Questions were included to test the generalizability of previous qualitative findings on BAR.

Results

Participants (N = 210) predominantly were aged between 25 and 35 years (69.2%), were in a relationship (96.2%), and had one child (80%). BAR was more commonly experienced when feeding the first-born child (44.8%), breastfeeding while pregnant (31%), or tandem feeding (10%). The feelings of aversion were experienced by most respondents throughout the feed while the child was latched (76.7%). More than half (52.4%) of participants reported that BAR had caused them to end breastfeeding sessions before their child was ready to stop feeding. Almost half of the participants (48.6%) reported receiving no support from a health care provider for BAR.

Discussion

This study contributes new information about the experience of BAR, including when it commonly happens and who may be at greater risk. More support is needed for women who want to breastfeed while experiencing BAR. New public health policies which promote breastfeeding are needed to help women achieve satisfying breastfeeding experiences and meet their own breastfeeding goals.     

Focal epilepsies: Update on diagnosis and classification

Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic–clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults. In children, focal epilepsies are typically subdivided in three groups: self-limited focal epilepsy syndromes (e.g., self-limited epilepsy with centrotemporal spikes), focal epilepsy of unknown cause but which do not meet criteria for a self-limited focal epilepsy syndrome, and focal epilepsy of known cause (e.g., structural lesions—developmental or acquired). In adults, focal epilepsies are often acquired and may be caused by a structural lesion such as stroke, infection and traumatic brain injury, or brain tumors, vascular malformations, metabolic disorders, autoimmune, and/or genetic causes. In addition to seizure semiology, neuroimaging, neurophysiology, and neuropathology constitute the cornerstones of a diagnostic evaluation. Patients with focal epilepsy who become drug-resistant should promptly undergo assessment in an epilepsy center. After excluding pseudo-resistance, these patients should be considered for presurgical evaluation as a means to identify the location and extent of the epileptogenic zone and assess their candidacy for a surgical procedure. The goal of this seminar in epileptology is to summarize clinically relevant information concerning focal epilepsies. This contributes to the ILAE's mission to ensure that worldwide healthcare professionals, patients, and caregivers continue to have access to high-quality educational resources concerning epilepsy.     

A novel approach for characterization of KSHV-associated multicentric Castleman disease from effusions

A biopsy of lymphoid tissue is currently required to diagnose Kaposi sarcoma-associated herpesvirus (KSHV)-associated multicentric Castleman disease (KSHV–MCD). Patients showing clinical manifestations of KSHV–MCD but no pathological changes of KSHV–MCD are diagnosed as KSHV inflammatory cytokine syndrome. However, a lymph node biopsy is not always feasible to make the distinction. A pathognomonic feature of lymph nodes in KSHV–MCD is the expansion of KSHV-infected, lambda-restricted but polyclonal plasmablasts. To investigate whether these cells also reside in extra-nodal sites, effusion from 11 patients with KSHV–MCD and 19 with KSHV inflammatory cytokine syndrome was analysed by multiparametric flow cytometry. A distinct, lambda-restricted plasmablastic population (LRP) with highly consistent immunophenotype was detected in effusions in 8/11 patients with KSHV–MCD. The same population was also observed in 7/19 patients with KSHV inflammatory cytokine syndrome. The detection of LRP stratified KSHV inflammatory cytokine syndrome into two clinically distinct subgroups; those with detectable LRP closely resembled KSHV–MCD, showing similar KSHV viral load, comparable severity of thrombocytopenia and hypoalbuminaemia, and similar incidences of hepatosplenomegaly. Collectively, the detection of LRP by flow cytometry can serve as a valuable tool in diagnosing KSHV–MCD. KSHV inflammatory cytokine syndrome with LRP in effusions may represent a liquid-form of KSHV–MCD.     

Fruits and Vegetables and the Risk of Stroke

Combining data from two large-scale prospective observational studies in women and men, investigators link the consumption of fruits and vegetables to the risk of ischemic stroke. Of interest is their breakdown of these foods into cruciferous vegetables and citrus fruit juice, which confer the greatest protection.     

Modification of the noradrenergic cyclic AMP generating system in the rat limbic forebrain by amphetamine: Role of its hydroxylated metabolites

Summary The cyclic AMP responses to norepinephrine (NE) in slices of the rat limbic forebrain after the administration of (S)-amphetamine and the role of its para- and -hydroxylated metabolites were investigated. The chronic but not acute administration of (S)-amphetamine to rats causes a significant reduction in the sensitivity of the cyclic AMP generating system to NE without changing the basal level of the nucleotide. This change in the sensitivity of the system is not associated with a change in the EC₅₀ value for NE but reflects mainly a decrease in the maximal response. After withdrawal of the drug, the cyclic AMP response to NE returned to control values within 4 days. In vitro, (S)-p-hydroxyamphetamine (POH) and all stereoisomers of p-hydroxynorephedrine (PHN) except (S,R)-PHN enhanced the cyclic AMP response to low concentrations of NE. Since (S,R)-PHN [like the other stereoisomers of PHN and (S)-POH] inhibited in a dose-dependent manner the high affinity uptake of ³H-NE into crude synaptosomal fractions of the limbic forebrain, the results might suggest that the presumably physiological enantiomer of PHN also exerts receptor blocking properties. The inhibition by (S,R)-PHN of the cocaine induced potentiation of the cyclic AMP response to NE supports this supposition. The results provide evidence that the hydroxylated metabolites of (S)-amphetamine, (S)-POH and (S,R)-PHN, modify the action of the parent drug on central noradrenergic function at the level of the NE receptor coupled adenylate cyclase system.