Partner Dissatisfaction Research Articles

Prevalence of insomnia and associated factors among postpartum mothers in Mattu City, Southwest Ethiopia: a community-based study

BackgroundInsomnia during the postpartum period has short-term and long-lasting effects on the health of the mother and her baby. Hence, this study assessed the prevalence of insomnia and its associated factors among postpartum mothers in Mattu City.MethodsA community-based cross-sectional study was conducted among randomly selected 451 postpartum mothers in Mattu City from May 1 to June 1, 2022. A structured questionnaire was used to conduct a face-to-face interview. Athens’s Insomnia Scale (AIS) standardized tool was used to measure insomnia. EpiData version 4.4.2.1 and Statistical Package for Social Sciences version 26 were used for data entry and analysis, respectively. Factors significantly affecting insomnia were identified using a binary logistic regression analysis at a p-value of less than 0.05.ResultsThe prevalence of insomnia was found to be 29.3% (95% CI: 25, 33.5). Parity (AOR = 3.36; 95% CI: 1.88, 5.60), unplanned pregnancy (AOR = 6.15; 95% CI: 5.23, 11.55), lack of postnatal follow-up (AOR = 3.82; 95% CI: 1.85, 7.90), partner dissatisfaction with the gender of the current baby (AOR = 5.73; 95% CI: 3.23, 10.2), partner daily alcohol use (AOR = 3.12; 95% CI: 1.66), and postpartum intimate partner violence (AOR = 2.60; 95% 4.67) were found to be factors significantly associated with insomnia.ConclusionsGenerally, three in ten mothers were suffering from insomnia in the study area. Therefore, health professionals and health extension workers need to endorse and enhance the counseling of the postpartum mother and her partner jointly. In addition, the media and other concerned bodies should focus on the identified factors to overcome them.

The Communication Patterns between Online Transportation Applicators and Driver Partners in Bandung

The online transportation industry is growing rapidly in the city of Bandung. Therefore, understanding the public relations communication patterns applied by online transportation applicators is very important. Effective communication patterns can strengthen relationships, increase trust levels, and increase partner loyalty to the company. However, if the communication pattern is not appropriate, it can cause obstacles, conflicts, and partner dissatisfaction. This study aims to analyze the communication patterns of public relations in online transportation applications with driver partners in the city of Bandung. The research method is descriptive-qualitative, with data collection techniques through interviews with eight driver partners of online transportation applications. The scientific findings show that communication barriers between applicators and driver-partners are related to differences in language, culture, communication understanding, and limited communication channels. However, applicators have implemented persuasive communication approach strategies by providing communication channels such as online forums and offline meetings to facilitate communication with partners. In conclusion, the importance of understanding and handling communication barriers in the public relations relationship between online transportation applicators and driver-partners Effective communication and the use of appropriate communication channels can strengthen working relationships, increase partner satisfaction, and build long-term loyalty.

Late postpartum depression and associated factors: community-based cross-sectional study

BackgroundLate postpartum depression is the presence of depressive symptoms beyond the early postpartum period and is a significant mental health problem that has a devastating impact on mothers, infants, partners, family members, the healthcare system, and the world’s economy. However, there is limited information regarding this problem in Ethiopia.ObjectiveTo assess the prevalence of late postpartum depression and associated factors.Methodthe community-based cross-sectional study was employed among 479 postpartum mothers in Arba Minch town from May 21 to June 21, 2022. The pre-tested face-to-face interviewer administered a structured questionnaire used to collect the data. A bivariate and multivariable analysis was done using a binary logistic regression model to identify factors associated with late postpartum depression. Both crude and adjusted odds ratios with 95% CI were calculated, and a p-value of < 0.05 was used to declare statistically significant factors.ResultThe prevalence of late postpartum depression was 22.98% (95% CI: 19.16, 26.80). Husband Khat use (AOR = 2.64; 95% CI: 1.18, 5.91), partner dissatisfaction with the gender of the baby (AOR = 2.53; 95% CI: 1.22, 5.24), short inter-delivery interval (AOR = 6.80; 95% CI: 3.34, 13.84), difficulty to meet husband sexual need (AOR = 3.21; 95% CI: 1.62, 6.37), postpartum intimate partner violence (AOR = 4.08; 95% CI: 1.95, 8.54), and low social support (AOR = 2.50; 95% CI: 1.25, 4.50) were significantly associated factors at p-value < 0.05.ConclusionOverall, 22.98% of mothers suffered from late postpartum depression. Therefore, based on the identified factors, the Ministry of Health, Zonal Health Departments, and other responsible agencies should establish effective strategies to overcome this problem.

The role of power-based behaviours on pharmaceutical supply chain resilience

PurposeThis study aims to explore the effect of power-based behaviours on pharmaceutical supply chain (PSC) resilience.Design/methodology/approachThis study used a mixed-method approach to explore the role of power-based behaviours in PSC resilience. Qualitative interviews from 23 key PSC stakeholders, followed by thematic analysis, revealed the underlying perceptions regarding PSC resilience. Quantitative propositions were then developed based on the themes adopted from PSC resilience literature and the qualitative findings. These were tested via a survey questionnaire administered to 106 key stakeholders across the various levels in the PSC. Structural equation modelling with partial least squares was used to analyse the data.FindingsThe data analysed identified proactive and reactive strategies as resilience strategies in the PSC. However, power-based behaviours represented by quota systems, information and price control influenced these resilience strategies. From a complex adaptive system (CAS) perspective, the authors found that when power-based behaviours were exhibited, the interactions between PSC actors were mixed. There was a negative influence on reactive strategies and a positive influence on proactive strategies. The analysis also showed that PSC complexities measured by stringent regulations, long lead times and complex production moderated the effect of power-based behaviour on reactive strategies. Thus, the negative impact of power-based behaviours on reactive strategies stemmed from PSC complexities.Research limitations/implicationsThis research particularly reveals the role of power-based behaviours in building PSC resilience. By evaluating the nexus from a CAS perspective, the analysis considered power-based behaviours and the moderating role of PSC complexities in developing resilience strategies. This study considers the interactions of PSC actors. This study shows that power asymmetry is a relational concept that inhibits the efficacy of reactive strategies. This study thus advocates the importance of power in achieving a more resilient PSC from a holistic perspective by highlighting the importance of the decision-making process among supply chain (SC) partners. The findings are particularly relevant if PSC resilience is viewed as a CAS. All the interactions and decision-making processes affect outcomes because of their inherent complexities. Although this study focused on the PSC, its implications could be extended to other SCs.Practical implicationsThe authors identified that power-based behaviours influenced resilience strategies. It was detrimental to reactive strategies because of the complexities of the PSC but beneficial to proactive strategies through resource-sharing. PSC actors are therefore encouraged to pursue proactive strategies as this may aid in mitigating the impact of disruptions. However, power-based behaviours bred partner dissatisfaction. This dissatisfaction may occur even within strategic alliances indicating that power could be detrimental to proactive strategies. Therefore, it is pertinent to identify conditions that lead to dissatisfaction when pursuing strategic partnerships. This study provides insight into actual behaviours influencing resilience and quantifies their effects on the PSC. These insights will be valuable for all SC partners wanting to improve their resilience strategies.Originality/valuePrevious PSC management and resilience studies have not examined the role of power in building resilience in the PSC. This paper thus provides a unique contribution by identifying the role of power in PSC resilience, offers empirical evidence and a novel theoretical perspective for future practice and research in building PSC resilience strategies.

“O” No: A Reddit Analysis of Orgasmic Dysfunction

ABSTRACT Introduction Orgasmic dysfunction includes reduced orgasmic intensity, decreased orgasm frequency and inability to achieve orgasm. Issues with orgasming are often multi-factorial in origin and can cause significant distress to patients. Objective We aimed to evaluate the experience of women with orgasmic dysfunction on Reddit, an anonymous forum-based platform that allows users to interact with a global audience. Methods The subreddit “TwoXChromosomes” was queried using the Reddit Application Programming Interface (API) for posts using the keywords “orgasm” and “climax”. Posts that were deleted, archived or unrelated to themes of orgasm were excluded. Threads were qualitatively analyzed using the grounded theory approach. Five independent researchers read and coded each thread identifying dominant themes and emergent concepts. Results Qualitative analysis of 108 threads and approximately 6,300 comments resulted in 5 major categories: psychological aspect of orgasms, difficulty orgasming with partners, partners’ response to orgasmic dysfunction, types of orgasms, and treatments for orgasmic dysfunction. Preliminary themes included (1) the presence of an emotional component or history of trauma resulting in orgasmic difficulty, (2) difficulty orgasming with a partner regardless of ability to orgasm during masturbation, and mixed partner responses to orgasmic dysfunction, with approximately half of posters reporting a supportive sexual partner who was interested in their sexual satisfaction while the remainder of posters reported partner dissatisfaction. (3) variety of stimulation required to orgasm, (4) the definition of a “normal orgasm and (5) self-motivated treatment for orgasmic dysfunction, including clitoral stimulation devices and masturbation techniques, with few posters discussing their orgasmic dysfunction with health care providers. Conclusions Overall, Reddit provides a medium for individuals with orgasmic dysfunction to discuss their experiences. Posts addressed users’ inability to orgasm, the interplay with their mental health and relationships, types of stimulation and treatments. Interestingly, very few posts discussed seeking out medical care for orgasmic dysfunction, potentially suggesting that women do not classify their orgasmic dysfunction as a health issue. The obvious prevalence of orgasmic dysfunction with little discussion surrounding healthcare reveals a large gap in sexual health counseling, indicating the need for expanded sexual health screening and detailed clinician-patient counseling. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raliegh, NC), Absorption Pharmaceuticals, Urovant Sciences, Inc.

EVALUATION OF PATIENTS’ SATISFACTION AFTER RHINOPLASTY: A PROSPECTIVE STUDY

Background: Rhinoplasty is a technically demanding procedure, requiring a comprehensive understanding of the nasal and facial anatomy and carrying out the nasofacial analysis. These factors are critical in determining the operative plan and the most effective technique that manipulates cartilage, bone, and soft tissue. The ultimate aim of rhinoplasty is to satisfy the patients with post-operative aesthetic and functional outcomes. Objective: To assess the long-term functional and aesthetic satisfaction among a sample of Egyptian patients subjected to rhinoplasty. Patients and Methods: This was a prospective cohort study conducted at Al-Azhar University Hospitals from May 2014 to May 2019. Patients aged more than 22 years of both sexes subjected to rhinoplasty, and presented in the outpatient clinics for follow-up were included. Post-operative counseling with the patients about the pre-operative conditions and deformities was done. Patients’ satisfaction was assessed using the rhinoplasty outcome evaluation questionnaire. Results: This study included a total of 30 patients. Of them, there was 3 (10%) male and 27 (90%) females with a mean age of 38.1±6.91years. The mean level of Rhinoplasty outcome evaluation questionnaire was 77.1±6.91. Out of the included patients, 17 (56.66%) patients were satisfied with their aesthetic and functional rhinoplasty outcomes and were presented only for follow-up. Of the remaining 13 (43.33%) cases, four (13.3%) cases required secondary correction due to functional problems and complained of headache and difficulty breathing. Two patients were dissatisfied due to partner dissatisfaction that developed significant psychological impact. Conclusion: A considerable proportion of patients were dissatisfied after rhinoplasty. The major contributing factors are related to functional and aesthetic problems, as well as psychological morbidities. Therefore, patients seeking rhinoplasty should be subjected to thoroughly functional and psychological evaluation preoperatively to achieve the desired functional and aesthetic outcomes.

Risk Factors for Postpartum Depression: An Umbrella Review.

A deeper understanding of risk factors for postpartum depression (PPD) is essential to better target prevention and screening. An umbrella review was conducted to summarize and synthesize previously published systematic reviews and meta-analyses. Eight databases were searched in October of 2016, including PubMed, CINAHL, MEDLINE, PsycINFO, Embase, SCOPUS, PsycEXTRA, and Cochrane. Studies were included if they were reviews examining one or more risk factors for PPD and published between 1996 and 2016. The final sample included 21 articles, which varied in numerous ways, including the scope of risk factors explored and statistical methods. Because of methodological variations between reviews, standardized statistical aggregation was not possible. From this body of literature, 25 statistically significant risk factors emerged with 2 additional risk factors presenting inconclusive findings. The most common risk factors identified were high life stress, lack of social support, current or past abuse, prenatal depression, and marital or partner dissatisfaction. The 2 strongest risk factors for PPD were prenatal depression and current abuse. Because untreated PPD leaves women and their children vulnerable to numerous negative short-term and long-term outcomes, a better understanding of PPD risk factors serves to improve maternal and child outcomes by allowing health care providers to better anticipate the needs of affected women.

204 Patient and Partner Satisfaction Rates after Penile Prostheses Surgery: A Systematic Review

Setting expectations is critical to postoperative satisfaction rates for patients. Providers counseling for Penile Prosthesis (PP) often cite high levels of satisfaction, although the body of evidence (BES) supporting these claims are based on observational studies. To better understand how to counsel patients and their partners, we performed a systematic review to assess satisfaction rates after PP surgery. We performed Pubmed, Embase, and Cochrane searches for eligible articles published between 1/1/65-7/29/17 to identify articles reporting the use of PP. The BES was assigned a strength rating of A (high), B (moderate), or C (low) using the AUA rating system. We reviewed 267 articles; of which 61 study arms (SA) reported patient satisfaction rates and 22 SA reported partner satisfaction rates after PP surgery. The BES was low (Grade C). The most commonly utilized outcome measure was the percentage of patients who reported satisfaction with PP. The mean satisfaction rate for Inflatable Penile Prosthesis (IPP) was 86.2% compared to 72.1% for MP. Older patient age, revision of penoscrotal web, lower preoperative expectations, and higher partner Female Sexual Function Index scores were associated with higher satisfaction rates. Partner dissatisfaction was associated with revisions, insufficient concealment, and a sense of unnaturalness of the device.

Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation

IntroductionA shorter penis is a frequent complaint following penile prosthesis implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length. AimTo evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL). MethodsIn 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed. Main Outcome MeasureEvaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler). ResultsNo infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P < .0001. Partner satisfaction showed a 40.2% increase, from 1.77 ± 0.61 to 4.41 ± 0.50, P < .0001. 19 of 22 patients reported that postoperative length was longer than their recall of erect length before ED had set in, and 3 patients reported that length was the same. With the implant rigid, there was no statistically significant difference in visible length between the supine and standing positions (14.1 cm ± 2.3 and 13.9 cm ± 2.3, respectively, P = .38). Clinical ImplicationsPatients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length. Strength & LimitationsStrengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion. ConclusionSame-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates.Shaeer O, Shaeer K, Abdel Rahman IF. Simultaneous suprapubic lipectomy and penile prosthesis implantation. J Sex Med 2018;15:1818–1823.

My boyfriend feels my strings! What do I do?

Objectives: Partners’ reactions to strings are not usually mentioned as an adverse effect of IUDs. Studies have shown that 3%–9% of respondents report partner dissatisfaction and discontinuation. Our study aimed to determine whether male partners felt IUD strings during sexual intercourse. Patients were asked if this interfered with sexual intercourse and what they did as a result.

Contraceptive Implant Discontinuation in Huambo and Luanda, Angola: A Qualitative Exploration of Motives.

Introduction The Government of Angola is engaged in ongoing efforts to increase access to contraceptives, in particular contraceptive implants (CIs). Discontinuation of CIs, however, has been identified as being a challenge to this work, hindering the improvement of contraceptive prevalence, and in turn, maternal and child health. The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. Methods We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics across the provinces of Huambo and Luanda. Data collectors transcribed and translated key information from Portuguese into English. We used a combined deductive/inductive approach to code and analyze data. Results Participants described adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion as motives for discontinuation. Adverse side effects, including prolonged bleeding, amenorrhea, and headaches were most commonly cited by both clients and providers. Discussion Motives for discontinuation reflect existing findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

Parenting self-efficacy moderates linkage between partner relationship dissatisfaction and avoidant infant-mother attachment: A Dutch study.

The early infant-mother attachment relationship is part of a network of close relationships in which the relationship between parents is especially relevant. Evidence for linkages between maternal satisfaction with the partner relationship and infant-mother attachment is equivocal. The current study tested whether associations between partner relationship dissatisfaction and infant-mother attachment quality might be conditional on mothers' parenting self-efficacy. The bivariate effect of partner relationship dissatisfaction on infant-mother attachment as well as moderation of this effect by parenting self-efficacy was tested in a sample of 260 infant-mother dyads 1 year after birth. There was no direct effect of partner dissatisfaction on attachment. Unexpectedly, for high parenting self-efficacy, greater partner dissatisfaction increased the odds of an avoidant infant attachment (compared with a disorganized) whereas, for low parenting self-efficacy, greater partner dissatisfaction decreased the odds of an avoidant infant attachment (compared with secure and disorganized). Findings underline the importance of parenting cognitions for understanding contextual factors of infant-mother attachment quality. (PsycINFO Database Record

Does age affect the relationship between control at work and sleep disturbance for shift workers?

Among miners, shift work, aging and lack of control at work may be factors leading to increased sleep problems. Such risk factors may also operate in interaction, resulting in an even increased harm for sleep disruption. The present study aims at evaluating these relationships drawing on a sample of Australian mine and energy workers and their partners. The workers were mainly men. All performed shift work that included either nights (95%) or multiple shifts (92%), usually both (87%), while 36% were aged 50 years or above. The results show that low latitude over work activities is associated with higher sleep disturbances across the sample, though the effects are clearer amongst younger workers. By contrast, for younger workers, control over shift scheduling is not associated with sleep disturbances but for workers aged 50 or more, low control results in more sleep disturbance. Misalignment between shift workers and partner work schedules, and partner dissatisfaction with shift worker's employment and shift worker's work-life balance, are also associated with more sleep disturbances amongst shift workers.

Managing the Difficult Penile Prosthesis Patient

Inflatable penile prostheses (IPPs) are associated with excellent long-term outcomes and patient/partner satisfaction. A small percentage of patients remain dissatisfied, despite acceptable surgical results. This study aims to evaluate factors associated with patient satisfaction and dissatisfaction, define patient characteristics, which may identify elevated risk of postoperative dissatisfaction, and describe management strategies to optimize functional and psychological patient outcomes. A review of urologic and non-urologic cosmetic surgery literature was performed to identify factors associated with patient satisfaction/dissatisfaction. Emphasis was placed on articles defining "high risk" or psychologically challenging patients. Preoperative factors associated with patient satisfaction/dissatisfaction and character traits, which may identify elevated risk of postoperative dissatisfaction or otherwise indicate a psychologically challenging patient. Contemporary patient and partner satisfaction rates following IPP are 92-100% and 91-95%, respectively. Factors associated with satisfaction include decreased preoperative expectations, favorable female partner sexual function, body mass index ≤30, and absence of Peyronie's disease or prior prostatectomy. Determinants of dissatisfaction include perceived/actual loss of penile length, decreased glanular engorgement, altered erectile/ejaculatory sensation, pain, diminished cosmetic outcome, difficulty with device function, partner dissatisfaction and perception of unnatural sensation, complications, and extent of alternative treatments offered. Personality characteristics which may indicate psychologically challenging IPP patients include obsessive/compulsive tendencies, unrealistic expectations, patients undergoing revision surgery, those seeking multiple surgical opinions, feeling of entitlement, patients in denial of their prior erectile/sexual function and current disease status, or those with other psychiatric disorders. The mnemonic CURSED Patient is presented: "Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric." Although the majority of IPP patients experience excellent, durable satisfaction and outcomes, a challenging subset of patients may be at increased risk of postoperative dissatisfaction. Appropriate recognition/prevention and management of this cohort may help to establish and strengthen relationships, reduce physical, emotional, and legal risk, and ultimately enhance patient satisfaction.

Effect of hypospadias on sexual function and reproduction

Hypospadias is a highly prevalent congenital anomaly. The impact of the defect and operative interventions on sexual and reproductive function has been addressed by few publications. It is essential to know the possible outcomes of intervention for appropriate counseling, operative planning, and follow-up. English articles indexed in Pubmed dealing with the long-term sexual and reproductive outcome following hypospadias repair from 1965 to 2007 were reviewed. To our knowledge, there was no prospective trial comparing the impact of various techniques on sexual outcome. There is considerable discordance in literature regarding the effects on sexual function. A few publications report patient and partner dissatisfaction with the appearance of genitalia. Sexual dissatisfaction is often attributed to penile size. Ejaculatory disturbances range between 6 and 37% of operated individuals. There is no convincing evidence for impaired fertility. The long-term follow-up is essential to identify problems and to address them appropriately. Literature documenting the outcome of specific operative procedures and analysis based on severity of hypospadias will be informative. The long-term follow-up of the newer techniques which are more commonly used are awaited.

INFLUENCE OF TRAINING ON THE FAMILY

There is currently a shortage of surgeons working in rural Australia. This may be due to partner dissatisfaction with rural placements during training. A questionnaire encompassing logistic, financial and emotional aspects of peripheral placements was distributed to trainees and their partners. A similar questionnaire was also distributed to 25 rural surgical consultants. Seventy-four per cent of trainees were either married or in long-term relationships. A further 24% had children. The average number of residential moves per year of training was 0.74. Respondents reported difficulties that included accommodation suitability, general practitioner availability, financial burden and finding amenities such as school and crèches. Many (66%) partners had experienced high levels of isolation or loneliness, whereas some reported the development of a stress-related disorder, depression or anxiety. Most respondents indicated that their partner would influence their decision to work in a given location. Furthermore, 20% of consultant surgeons had either moved town or had seriously considered moving town because of their spouse or children's dissatisfaction. Training in peripheral locations causes significant stress to the trainee and their families. These experiences dissuade trainees from working in rural locations as consultants.

Assessment of sexual functions after spinal cord injury in Indian patients

This study assessed the interacting physical, psychological and social aspects of sexuality among 86 males and 14 females with spinal cord injury (SCI). Data collection involved the use of a 42-item study-specific questionnaire designed to determine different aspects of sexuality. Subjects were rated, after interview, on a scale according to an integrated index of sexual function (IISF). It was observed that patients scoring higher on this index were sexually more active and showed positive sexual adjustments. A higher incidence of complications of SCI, partner dissatisfaction, less partner co-operation, lower self-esteem and social taboos were factors responsible for less sexual activity in our patients. The present study suggests that there is a strong need for improved treatment of the medical complications of SCI, sexual counselling, literature, information and peer support in this country. We are of the opinion that the IISF can be utilized in rehabilitation settings to examine the interplay of the various complex factors in sexual rehabilitation post-SCI.

Social Risk and Protective Factors for Suicide Attempts in Low Income African American Men and Women

A case-control study was conducted to examine a broad array of potential social risk and protective factors for suicide attempt among 200 African American men and women receiving care at a large, public, urban hospital. Specifically, we examined the effect of the following potential risk factors for suicide attempt: life hassles, partner abuse, partner dissatisfaction, and racist events; as well as the following potential protective factors: effectiveness of obtaining resources, social embeddedness, and social support. Using logistic regression, suicide attempter status was predicted by two independently significant social variables: one risk factor (life hassles) and one protective factor (social support). Male versus female suicide attempters were not distinguished by the social variables. These findings, which support the utility of an ecological conceptualization of risk and protective factors for suicide attempt, help to clarify the independently significant social environment risk and protective factors for suicide attempts among economically disadvantaged African Americans in particular. Research on both risk factors and protective factors provide a basis for culturally competent interventions aimed at reducing both the risk of future suicide attempts and completions.

Nonverbal communication and marital adjustment and satisfaction: the role of decoding relationship relevant and relationship irrelevant affect

The present study investigates the relationship between nonverbal encoding and decoding of positive and negative affect attributed to relational and nonrelational factors and spouses' marital adjustment. Findings indicate that accuracy in decoding of nonverbal affect was associated with the partner's, but not one's own, marital satisfaction. In regard to specific relational and nonrelational affect, results showed that accurate decoding of relational positive affect and of nonrelational negative affect was associated with the decoder's marital satisfaction, while accurate decoding of relational positive affect was associated with the partner's dissatisfaction. In regard to nonverbal communication and sex differences, we found that husbands' decoding of wives' nonrelational affect was more predictive of marital satisfaction than wives' decoding of husbands' nonrelational affect. Overall, however, we did not find many of the sex differences in nonverbal communication reported in previous studies. Implications of these findings for our current understanding of nonverbal communication in marriages are discussed.

Intracavernosal therapy for erectile failure--impact of treatment and reasons for drop-out and dissatisfaction.

To examine the impact of intracavernosal therapy on libido, ejaculatory control, quality of life and treatment dependency in men with erectile failure. Furthermore to assess the drop-out rate and reasons for dissatisfaction with the technique. Questionnaires were sent to 1116 subjects with erectile failure who had previously elected to use intracavernosal therapy in the period 1995-1997. The response rate was 72.5%. The majority of erections lasted 30-60 min, 10-20% of the erections were considered unsatisfactory for intercourse and 15% of subjects reported erections lasting longer than 5 h on at least 10% of the occasions. Bleeding at the injection site occurred in 60% on at least 10% of the occasions and various degrees of deformation of the penis shaft were reported by 10%. The latter was related to the age of the subject and not the type of medication employed. Forty percent experienced at least partially improved control over ejaculation and almost 50% experienced some degree of increase in libido. One quarter retained penile rigidity after ejaculation but this was age-dependent. In those satisfied with intracavernosal treatment, 80% admitted that it had improved the quality of their lives. Sixty percent did not feel that their dependency on intracavernosal treatment had lessened during the treatment period. Approximately 40% of subjects admitted to dropping out of the programme, the majority within the first six months. The age of the subject did not influence the decision and the type of medication or the mode of injection had only a minor impact on drop-out rate. Of those currently using IC therapy, 87% were either fully or partly satisfied with this form of treatment. The corresponding figure for those discontinuing treatment was 58%. Dissatisfaction was higher in the younger age groups and could not be clearly related to the mode of injection. The major reasons for drop out or dissatisfaction were inadequate penile rigidity, the expense of the treatment, penile discomfort and the lack of spontaneity it necessitated. Penile discomfort was more associated with younger age groups, whilst an inadequate response to medication was more often experienced by men over 60 y. Deformation of the penile shaft was observed in 5% of those dissatisfied with IC therapy and was four times more often reported by those over 70 compared to subjects younger than 40 y. In 6% of cases, a return of spontaneous erections was given as reason for drop-out. This was more often associated with younger subjects. In 16% of the subjects, the partner had expressed dissatisfaction with the technique primarily because of inadequate rigidity, lack of spontaneity or the complicated nature of the treatment. Intracavernosal treatment for erection failure is associated with side-effects such as penile fibrosis and bleeding at the injection site but has advantages including increased libido, an increase in the quality of life and ejaculatory control. Only a small proportion of men reduce their dependency on the technique with time. The therapy has a relatively high attrition rate. In many cases, the reasons for subject and partner dissatisfaction are potentially correctable e.g. by altering the medication used, by the use of injector devices or by obtaining financial support for IC medication from medical welfare.