Erectile dysfunction negatively affects men and women in relationships; however, the subjective experience of erectile dysfunction and phosphodiesterase-type 5 inhibitor therapy remains poorly understood. The authors therefore characterized participants' subjective understanding of erectile dysfunction and phosphodiesterase-type 5 inhibitor therapy using individual interviews with affected heterosexual men (n = 58) and women (n = 65). Responses were characterized by 6 psychosocial domains: explanation of the experience, emotional responses, socially expected responses, value of sex, communication with the partner, and treatment expectations. The findings may aid clinicians in relating to men with erectile dysfunction and thus potentially improve effectiveness of therapy.

BACKGROUND:This study evaluated the measurement properties of a newly developed instrument - the Self-Management Profile for Type 2 Diabetes (SMP-T2D).METHODS:The 18-item SMP-T2D assesses 12 constructs: level and perceived ease of performance in five self-care domains (blood glucose monitoring, medication-taking, healthy eating, being physically active, and coping), and two global constructs (ease of weight management, confidence with ability to manage diabetes). Validation analyses were based on two studies involving 240 patients with T2D, Study 1 (Clinicaltrials.gov #NCT00637273) with SMP-T2D administration supplemented by SMP-T2D retest one week later, and Study 2 (Clinical trials.gov #NCT00877890) with SMP-T2D administration supplemented by 24-week SMP-T2D follow-up after medication change. Validation included clinical indicators and measures of patient reported quality of life, psychological well-being and treatment outcomes.RESULTS:All multi-item SMP-T2D measures showed acceptable internal consistency (alphas = 0.71 to 0.87); ten measures had test-retest reliability >0.75. Correlations among SMP-T2D measures and between SMP-T2D measures and validation measures, which were as hypothesized, provided evidence of convergent and discriminant validity. Scores for six SMP-T2D measures improved significantly during Study 2. Multiple regression analysis showed independent associations between change in SMP-T2D measures and change in trial outcomes from baseline to end-of-study.CONCLUSIONS:Two studies provide preliminary evidence regarding the reliability, validity and responsiveness of the SMP-T2D. Further research on the utility of the instrument is needed.

Objective: To characterize the spectrum of clinical outcomes achieved with depression treatment and the associated impact on quality of life (QOL), functional status, overall well-being, health-care costs, and productivity. Sources: Electronic databases including Medline were searched for English language sources between 1995 and 2007 using key words of depression, nonresponse, partial response, and remission and QOL, functional status, utility, cost, and productivity. Study selection: Relevant abstracts were obtained for 488 references and full-text articles were reviewed that included primary data. and compared outcomes by treatment response. Data. were abstracted from 26 full-text articles. Data abstraction: Detailed evidence tables were prepared with the relevant data as well as information on the study design. All data abstracted were checked for accuracy. Synthesis: Treatment remitters and partial responders reported clinically and statistically significant improvements in QOL, Junctional status, and overall well-being compared to nonresponders. Annual health-care costs and productivity losses were significantly lower for remitters and partial responders compared to nonresponders. Conclusions: The reduced disease burden for remitters and partial responders compared to nonresponders indicates that new treatment strategies that improve the rates of response/remission with initial treatment might have value to patients and to society. Depression and Anxiety 26:83-97, 2009. (c) 2008 Wiley-Liss, Inc.

Using Internet-based survey data, this study compared the demographic, psychosocial, relationship, and sexual characteristics of three groups of U.S. women: (a) women whose partners had erectile dysfunction (ED) and were taking medication to treat ED; (b) women whose partners had ED in the previous 3 months and were not taking medication to treat ED; and (c) a control group of women whose partners did not have ED. Results indicate that women are affected by their partners' ED and that ED treatment benefits women's sexual self-efficacy, communication about sexual issues, and sexual and relationship satisfaction.

PURPOSE:We examined whether men with erectile dysfunction are more likely to have diabetes mellitus than men without erectile dysfunction, and whether erectile dysfunction can be used as an observable early marker of diabetes mellitus. MATERIALS AND METHODS:Using a nationally representative managed care claims database from 51 health plans and 28 million members in the United States, we conducted a retrospective cohort study to compare the prevalence rates of diabetes mellitus between men with erectile dysfunction (285,436) and men without erectile dysfunction (1,584,230) during 1995 to 2001. Logistic regression models were used to isolate the effect of erectile dysfunction on the likelihood of having diabetes mellitus with adjustment for age, region and 7 concurrent diseases. RESULTS:The diabetes mellitus prevalence rates were 20.0% in men with erectile dysfunction and 7.5% in men without erectile dysfunction. With adjustment for age, region and concurrent diseases, the odds ratio of having diabetes mellitus between men with erectile dysfunction and without erectile dysfunction was 1.60 (p <0.0001). With adjustment for regions and concurrent diseases, the age specific odds ratios ranged from 2.94 (p <0.0001, age 26 to 35) to 1.05 (p = 0.1717, age 76 to 85). CONCLUSIONS:Men with erectile dysfunction were more than twice as likely to have diabetes mellitus as men without erectile dysfunction. Erectile dysfunction is an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.

Although erectile dysfunction (ED) has been considered a complication of other medical conditions, clinicians and researchers suggest that ED may serve as a clinical marker of vascular health. This retrospective claims study examined the prevalence of predefined comorbid conditions in men with ED (N=301 994) in the 12 months before and the 6 months following ED diagnosis. Consistent with previous research, comorbid conditions were prevalent among men with ED. Comorbid conditions were most often diagnosed before an ED diagnosis, although new diagnoses in the 6 months following an ED diagnosis were common and occured more frequently than new diagnoses in a matched sample of men without ED during the same period. Differences by age, region and insurance coverage for ED medications were also examined. Findings support previous research that suggests ED may serve as a marker for previously undetected comorbid conditions.

Purpose: The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function.Type of Study: Longitudinal, prospective study.Methods: Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively. Patients and their physicians completed ratings on knee pain and function at each time point. In addition, at their preoperative visit, patients and physicians completed ratings predicting their postoperative pain and functional status.Results: Physicians rated patients as having less pain and greater knee function preoperatively and at 24 weeks postoperatively. Patients had more significant differences between predicted and actual ratings.Conclusions: Physicians tended to underestimate knee pain and overestimate knee function compared with patients. However, physicians better predicted postoperative knee pain and function ratings than did patients. These findings suggest that physician-patient discussions about preoperative expectations and postoperative reality might be an important part of clinical care. Level of Evidence: Level 11, Prospective Longitudinal Study.

Sexual and relationship characteristics of men in the general population, particularly those with erectile dysfunction (ED), are not well established. This Internet-based survey (N = 700) examined demographic, sexual, and relationship characteristics of two groups of men aged 40–70: those with no ED (n = 589) and those with probable ED (n = 111). Compared to men without ED, men in the ED sample were significantly older, had more medical conditions, and had significantly worse sexual, psychological, and relationship function. Sexual function and relationship and psychological characteristics were significant predictors of overall sexual satisfaction and relationship satisfaction.

ABSTRACT Introduction Studies of erectile dysfunction (ED) therapies typically assess erectile function end‐ points, although other treatment outcomes may also be of value to men and their partners. Aim To examine the treatment sensitivity of the Psychological and Interpersonal Relationship Scales (PAIRS) associated with the use of two phosphodiesterase type 5 (PDE5) inhibitors with different duration of action. Methods Men with ED were recruited from three clinical trials of tadalafil and sildenafil citrate to complete post‐treatment questionnaires that included the PAIRS. In Study 1 , the PAIRS was assessed after 6 months of open‐label tadalafil (20 mg) treatment and after 2 months of real‐world sildenafil use (25–100 mg). In studies 2 and 3, the PAIRS was assessed at the end of the trial assessment phase. In Study 2 , men with a 6–24 week history of sildenafil use (25–100 mg) received 3 weeks of open‐label sildenafil treatment (dosage at study entry), and then switched to 9 weeks of tadalafil treatment. In Study 3 , a double‐blind, crossover study, men were randomized to 12 weeks of either tadalafil (20 mg) or sildenafil (50 mg) treatment, followed by 12 weeks of the alternate treatment; PAIRS scores for the second treatment period were evaluated. Main Outcome Measure Treatment outcomes were assessed with the PAIRS, a new reliable and valid self‐report measure of sexual self‐confidence, spontaneity, and time concerns before sex. Results Significant mean differences were observed on all PAIRS domain scores associated with tadalafil and sildenafil treatment. Across studies, men had significantly higher sexual self‐confidence and spontaneity scores, and lower time concerns scores in reference to tadalafil compared with their scores in reference to sildenafil. Conclusions Mean differences observed on PAIRS domains across studies support the sensitivity of the measure to differentiate between these two ED treatments.

Erectile dysfunction (ED) is a prevalent condition associated with complex psychological and interpersonal issues. The Psychological and Interpersonal Relationship Scales (PAIRS) is a valid and reliable measure of Sexual Self-Confidence, Spontaneity, and Time Concerns associated with ED and its treatment. This paper describes the development and validation of a 15-item, short form of PAIRS (SF-PAIRS). Domain scores and psychometric properties of SF-PAIRS were assessed using data from the validation studies of the full-length (23-item) PAIRS. Items in the two briefer scales (Spontaneity and Time Concerns) were identified using internal consistency analyses and crossvalidated during two multinational clinical trials and a community sample. The scales in SF-PAIRS showed good internal consistency, convergent and discriminant validity, were stable over a 2-week period, and showed sensitivity to treatment. SF-PAIRS is a valid, brief measure of psychological and interpersonal outcomes associated with ED.

Using the data from two ongoing studies of resilience and thriving one of gay men growing up in heterosexist environments, the other of women living with AIDS, we review how qualitative approaches have enabled researchers to grapple with conceptual, methodological, and ethical dilemmas related to the study of resilience and thriving. We discuss the implications our values as researchers have on determining who is thriving; the powerful social, cultural, and political contexts that must be considered when investigating the effects of and resistance to adversity; and the implications of conceptualizing thriving as a process. Finally, we consider the opportunities opened up by qualitative analysis and suggest some avenues for future research.

Used an ecological framework to explore what contextual factors (interpersonal, sociocultural, medical, and temporal) relate to rheumatic disease patients' perceptions of helpful and unhelpful social support. Data are presented from two studies, one of recently diagnosed rheumatoid arthritis patients (n = 62) and another of patients with rheumatic diseases of longer duration (n = 113). Respondents described the most helpful and least helpful episodes of support received. Responses were coded for type of support (emotional, tangible, informational, critical remarks) and support provider (spouse, medical professional, kin, or friend). In both studies, the perceived helpfulness of particular types of support varied by provider. Both the most and least helpful episodes involved emotional support from the spouse or tangible support from medical professionals. Other contextual variables were less strongly related to support perceptions. The findings suggest that illness contexts may create needs for certain types of support from particular providers and that unfulfilled needs may contribute to perceptions of support as unhelpful.

Domestic and international tourism in New Zealand has grown significantly in the past decade and shows every sign of continuing to do so. A vital component of the tourism industry is the accommodation sector. Over 3000 accommodation enterprises employ more than 20,000 New Zealanders on a full time equivalent (FTE) basis and bring important economic benefits to both rural and urban settings. The accommodation sector is characterised by considerable uptake of new information and communication technologies (ICT) in areas such as bookings, property management and back-office functions. This report aims to create a better understanding of how ICT adoption is influencing the demand for, and use of, labour in this important sector, and how enterprise owners and managers feel about the training issues that stem from influences. Our research is based on: (i) a review of global and local research in tourism, ICT and labour use; (ii) in-depth interviews with 160 small accommodation providers conducted between 1998-2004; (iii) in-depth interviews with 6 large hotels in the Auckland region; and (iv) a nation-wide survey of accommodation providers (468 responses). Our findings reveal that ICT adoption is having important impacts on labour use and demand in both small and large enterprises, but that we need to view these as part of a broader evolution in the competitive context within which the sector operates. We conclude with the presentation of our major findings and some thoughts on approaches that may enhance the ability of the accommodation sector to cope with the complex interactions between ICT adoption and labour use.